Healthcare Provider Details

I. General information

NPI: 1811359219
Provider Name (Legal Business Name): ROBERT ACHIMOV PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 MAIN STREET
LAKE COMO NJ
07719-3097
US

IV. Provider business mailing address

1719 MAIN STREET
LAKE COMO NJ
07719-3097
US

V. Phone/Fax

Practice location:
  • Phone: 732-894-9200
  • Fax: 732-894-9202
Mailing address:
  • Phone: 732-894-9200
  • Fax: 732-894-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01646500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: