Healthcare Provider Details

I. General information

NPI: 1245282755
Provider Name (Legal Business Name): ROBERT L TUCKER MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RAILROAD AVE
MONTVALE NJ
07645-2111
US

IV. Provider business mailing address

33 BURNETT PL
NUTLEY NJ
07110-2401
US

V. Phone/Fax

Practice location:
  • Phone: 201-491-8400
  • Fax: 201-491-9400
Mailing address:
  • Phone: 201-491-8400
  • Fax: 201-491-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00876900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: