Healthcare Provider Details

I. General information

NPI: 1245693449
Provider Name (Legal Business Name): TENAFLY THERAPY GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W IVY LN
ENGLEWOOD NJ
07631-6705
US

IV. Provider business mailing address

14 VENUS DR
CLOSTER NJ
07624-2316
US

V. Phone/Fax

Practice location:
  • Phone: 201-580-5085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: YAEL OMER
Title or Position: OWNER AND CEO
Credential:
Phone: 201-580-5085