Healthcare Provider Details

I. General information

NPI: 1841787645
Provider Name (Legal Business Name): SPORTSMED PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 HARRISTOWN RD STE 200
GLEN ROCK NJ
07452-3354
US

IV. Provider business mailing address

266 HARRISTOWN RD STE 304
GLEN ROCK NJ
07452-3321
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
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: CAROL AZAR
Title or Position: BILLING DIRECTOR
Credential: RN
Phone: 201-857-0527