Healthcare Provider Details

I. General information

NPI: 1457545675
Provider Name (Legal Business Name): RUTHERFORD ALLIED MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 UNION AVENUE
RUTHERFORD NJ
07070
US

IV. Provider business mailing address

323 UNION AVENUE
RUTHERFORD NJ
07070
US

V. Phone/Fax

Practice location:
  • Phone: 201-933-4440
  • Fax:
Mailing address:
  • Phone: 201-933-4440
  • 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 TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J COONEY
Title or Position: VICE PRESIDENT
Credential: DC
Phone: 201-933-4440