Healthcare Provider Details

I. General information

NPI: 1013510627
Provider Name (Legal Business Name): TERRANOVA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JOCARDA DR
MIDDLETOWN NJ
07748-3337
US

IV. Provider business mailing address

10 JOCARDA DR
MIDDLETOWN NJ
07748-3337
US

V. Phone/Fax

Practice location:
  • Phone: 732-778-0830
  • Fax:
Mailing address:
  • Phone: 732-778-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENA CALABRESE
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 732-778-0830