Healthcare Provider Details

I. General information

NPI: 1215941976
Provider Name (Legal Business Name): PROSTHETIC AMBULATION CENTER OF EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 ANDERSON AVE
CLIFFSIDE PARK NJ
07010-1636
US

IV. Provider business mailing address

522 ANDERSON AVE
CLIFFSIDE PARK NJ
07010-1636
US

V. Phone/Fax

Practice location:
  • Phone: 201-943-3900
  • Fax: 201-943-9055
Mailing address:
  • Phone: 201-943-3900
  • Fax: 201-943-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MAUREEN ANNE VALENTI
Title or Position: SENIOR PHYSICAL THERAPIST
Credential: R.P.T.
Phone: 201-943-3900