Healthcare Provider Details

I. General information

NPI: 1992102339
Provider Name (Legal Business Name): CENTER FOR CHILDREN'S THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 POMPTON AVE STE 1-3
CEDAR GROVE NJ
07009-1043
US

IV. Provider business mailing address

1425 POMPTON AVE STE 1-3
CEDAR GROVE NJ
07009-1043
US

V. Phone/Fax

Practice location:
  • Phone: 973-785-9300
  • Fax:
Mailing address:
  • Phone: 973-785-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNA ANGELA LUPINACCI
Title or Position: DIRECTOR
Credential:
Phone: 973-785-9300