Healthcare Provider Details

I. General information

NPI: 1679735229
Provider Name (Legal Business Name): TOTAL ACTIVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PROSPECT AVE 225
HACKENSACK NJ
07601-2511
US

IV. Provider business mailing address

240 PROSPECT AVE 225
HACKENSACK NJ
07601-2511
US

V. Phone/Fax

Practice location:
  • Phone: 201-723-7149
  • Fax: 206-984-4749
Mailing address:
  • Phone: 201-723-7149
  • Fax: 206-984-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01256200
License Number StateNJ

VIII. Authorized Official

Name: MR. NITIN K CHHODA
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: M.S
Phone: 201-723-7149