Healthcare Provider Details

I. General information

NPI: 1801047717
Provider Name (Legal Business Name): ROBERT LETIZIA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 04/01/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HAMBURG TPKE SUITE 105
WAYNE NJ
07470-2154
US

IV. Provider business mailing address

401 HAMBURG TPKE STE 105
WAYNE NJ
07470-2139
US

V. Phone/Fax

Practice location:
  • Phone: 973-595-6066
  • Fax: 973-595-1127
Mailing address:
  • Phone: 973-689-7123
  • Fax: 973-840-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00975100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: