Healthcare Provider Details

I. General information

NPI: 1871215335
Provider Name (Legal Business Name): CEDAR GROVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 POMPTON AVE
CEDAR GROVE NJ
07009-1203
US

IV. Provider business mailing address

870 POMPTON AVE
CEDAR GROVE NJ
07009-1203
US

V. Phone/Fax

Practice location:
  • Phone: 973-433-0889
  • Fax:
Mailing address:
  • Phone: 973-433-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROTH RILEY
Title or Position: PHYSICIAN
Credential: MD
Phone: 973-742-6260