Healthcare Provider Details

I. General information

NPI: 1023947629
Provider Name (Legal Business Name): MICHAEL CORONA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SCHOOLEYS MOUNTAIN RD
HACKETTSTOWN NJ
07840-4012
US

IV. Provider business mailing address

32 DEPEW AVE
DOVER NJ
07801-4127
US

V. Phone/Fax

Practice location:
  • Phone: 917-763-4175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00425500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: