Healthcare Provider Details

I. General information

NPI: 1689506867
Provider Name (Legal Business Name): MODERN MOVEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 ENGLISH PL
BASKING RIDGE NJ
07920-2741
US

IV. Provider business mailing address

213 ENGLISH PL
BASKING RIDGE NJ
07920-2741
US

V. Phone/Fax

Practice location:
  • Phone: 516-790-2553
  • Fax:
Mailing address:
  • Phone: 516-790-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SOSUNOV
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 516-790-2553