Healthcare Provider Details

I. General information

NPI: 1487626347
Provider Name (Legal Business Name): OBJECTIVE DIAGNOSTIC & REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 PAULISON AVE
CLIFTON NJ
07011
US

IV. Provider business mailing address

1081 PAULISON AVE
CLIFTON NJ
07011
US

V. Phone/Fax

Practice location:
  • Phone: 973-253-6002
  • Fax: 973-253-1165
Mailing address:
  • Phone: 973-253-6002
  • Fax: 973-253-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40 QA00685700
License Number StateNJ

VIII. Authorized Official

Name: DR. HARRY MAROULAKOI
Title or Position: PRESIDENT
Credential:
Phone: 973-253-6002