Healthcare Provider Details

I. General information

NPI: 1992655096
Provider Name (Legal Business Name): PARAMUS SPORTS MEDICINE & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ROBIN RD STE 118
PARAMUS NJ
07652-1424
US

IV. Provider business mailing address

205 ROBIN RD STE 118
PARAMUS NJ
07652-1424
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-1511
  • Fax: 201-225-9731
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANALICIA BASTAS
Title or Position: PRACTICE MANAGER
Credential: MBA
Phone: 201-952-6409