Healthcare Provider Details

I. General information

NPI: 1669917464
Provider Name (Legal Business Name): SPORTSMED OF PARAMUS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S SPRING VALLEY RD
PARAMUS NJ
07652-2624
US

IV. Provider business mailing address

21 S SPRING VALLEY RD
PARAMUS NJ
07652-2624
US

V. Phone/Fax

Practice location:
  • Phone: 201-362-2289
  • Fax:
Mailing address:
  • Phone: 201-362-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROL AZAR
Title or Position: DIRECTOR OF BILLING
Credential: RN
Phone: 201-362-2289