EVERGREEN MEDICAL GROUP PC
NPI 1295516409
Physical Medicine & Rehabilitation in River Edge, NJ

Active since October 12, 2023CLIA 31D2321162 · Waiver
887 KINDERKAMACK RD STE 2, RIVER EDGE, NJ 07661(201) 464-0860(888) 440-2752 Get Directions Write a Review

NPPES record last updated: February 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 11, 2025, Feb 3, 2025, Oct 12, 2023 (3 updates tracked since 2023).

About Evergreen Medical Group Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN MEDICAL GROUP PC (NPI 1295516409) is a healthcare organization registered as a physical medicine & rehabilitation in River Edge, New Jersey and active in the NPI registry since October 2023. The organization holds a CLIA Waiver certificate valid through March 30, 2027, maintains a secondary practice location in Fair Lawn, and lists Grigory Shtender, Owner, as its authorized official.

NPPES Registry Identity

NPI1295516409
Entity TypeOrganization
Primary Taxonomy208100000X
Legal Business NameEVERGREEN MEDICAL GROUP PC
Location Address887 KINDERKAMACK RD STE 2River Edge, NJ 07661-2307
Mailing Address887 Kinderkamack Rd Ste 2River Edge, NJ 07661-2307 · (201) 464-0860
Fax(888) 440-2752
Organization SubpartNo
Authorized OfficialGrigory ShtenderOwner · (201) 791-7771
Enumeration DateOctober 12, 2023
Last NPPES UpdateFebruary 11, 20253 updates tracked since enumeration
NPPES CertifiedFebruary 11, 2025
NPI 1295516409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 10

Primary SpecialtyPhysical Medicine & RehabilitationAllopathic & Osteopathic Physicians
Taxonomy Code208100000X
Definition
Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
Also ListedChiropractorTaxonomy 111N00000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedSurgery · Vascular SurgeryTaxonomy 2086S0129X
Also ListedPodiatrist · Foot & Ankle SurgeryTaxonomy 213ES0103X
Also ListedPhysical TherapistTaxonomy 225100000X
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X
887 KINDERKAMACK RD STE 2, River Edge, NJ 07661

Secondary Practice Location 1

Location 131-00 BroadwayFair Lawn, NJ 07410-3963 · Phone (201) 791-7771 · Fax (201) 350-8614

Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2321162

Evergreen Medical Group · River Edge, NJ
Active · expires Mar 30, 2027
CLIA Number31D2321162
Laboratory TypePhysician Office
Certificate Effective DateMarch 31, 2025
Certificate Expiration DateMarch 30, 2027
Laboratory DirectorVasyl Pidkaminetskiy
Laboratory Phone(201) 464-0860
Laboratory LocationEvergreen Medical Group887 Kinderkamack Road, River Edge, NJ 07661
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine
887 KINDERKAMACK RD STE 2
RIVER EDGE, NJ 07661
Nurse Practitioner (Psychiatric/Mental Health)
887 KINDERKAMACK RD STE 2
RIVER EDGE, NJ 07661
Nurse Practitioner (Family)
887 KINDERKAMACK RD STE 2
RIVER EDGE, NJ 07661

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Medical Group PC's NPI number?

The NPI number for Evergreen Medical Group PC is 1295516409. It was assigned to this organization in the NPPES registry on October 12, 2023.

Where is Evergreen Medical Group PC located?

Evergreen Medical Group PC is located at 887 Kinderkamack Rd Ste 2, River Edge, NJ 07661. The listed phone number is (201) 464-0860.

What is Evergreen Medical Group PC's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation with taxonomy code 208100000X.

Does Evergreen Medical Group PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D2321162) is associated with this NPI, valid through March 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Evergreen Medical Group PC was last updated on February 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.