Healthcare Provider Details

I. General information

NPI: 1629898986
Provider Name (Legal Business Name): BOSCO PARK PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 GLENSIDE CT E
ORADELL NJ
07649-2413
US

IV. Provider business mailing address

762 GLENSIDE CT E
ORADELL NJ
07649-2413
US

V. Phone/Fax

Practice location:
  • Phone: 201-566-6398
  • Fax: 201-367-3482
Mailing address:
  • Phone: 201-566-6398
  • Fax: 201-367-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOSCO SEONGYEOL PARK
Title or Position: OWNER
Credential: PT, DPT
Phone: 201-566-6398