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General NPI Number Information
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NPI Number | 1023624012
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Entity Type | Organization
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Legal Business Name | TOTAL ACTIVCORE PC
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 719 ROUTE 206 STE 104
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1529
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Country | US
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Telephone | 908-262-7401
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Fax |
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Provider Business Mailing Address
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Address Line | 719 ROUTE 206 STE 104
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1529
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Country | US
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Telephone | 908-262-7401
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | NICHOLAS RYAN PASSE
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Credential |
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Telephone | 908-872-5133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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