Healthcare Provider Details

I. General information

NPI: 1043497571
Provider Name (Legal Business Name): THERAPRO-CORF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 KENNEDY BLVD
NORTH BERGEN NJ
07047-5361
US

IV. Provider business mailing address

9225 KENNEDY BLVD
NORTH BERGEN NJ
07047-5361
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-2701
  • Fax: 201-869-2717
Mailing address:
  • Phone: 201-869-2701
  • Fax: 201-869-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. RAVI TIKOO
Title or Position: CEO
Credential:
Phone: 917-536-8940