Healthcare Provider Details

I. General information

NPI: 1104589365
Provider Name (Legal Business Name): CORTICA NEW JERSEY DEVELOPMENTAL THERAPIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67A MOUNTAIN BOULEVARD EXT 1ST FLOOR, UNIT B
WARREN NJ
07059-2737
US

IV. Provider business mailing address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

V. Phone/Fax

Practice location:
  • Phone: 908-873-6337
  • Fax: 908-332-5668
Mailing address:
  • Phone: 858-216-8837
  • Fax: 888-383-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NEIL HATTANGADI
Title or Position: CEO
Credential: MD
Phone: 858-216-8837