Healthcare Provider Details

I. General information

NPI: 1568623536
Provider Name (Legal Business Name): LITTLE FERRY SPORTS, SPINE & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 WASHINGTON AVE
LITTLE FERRY NJ
07643-2009
US

IV. Provider business mailing address

167 WASHINGTON AVE
LITTLE FERRY NJ
07643-2009
US

V. Phone/Fax

Practice location:
  • Phone: 201-641-1600
  • Fax: 201-807-0231
Mailing address:
  • Phone: 201-641-1600
  • Fax: 201-807-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00665500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01102800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01032900
License Number StateNJ

VIII. Authorized Official

Name: DR. CHARLES TERRANOVA
Title or Position: OWNER
Credential: D.C.
Phone: 201-641-1600