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General NPI Number Information
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NPI Number | 1275050619
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Entity Type | Organization
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Legal Business Name | TALARIA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/26/2017
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 100 UNION AVE STE 200
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City | CRESSKILL
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State | NJ
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Zip | 07626-2137
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Country | US
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Telephone | 201-588-6290
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Fax | 201-588-6059
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Provider Business Mailing Address
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Address Line | 56 JACKSON AVE
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City | HAWORTH
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State | NJ
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Zip | 07641-1450
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Country | US
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Telephone | 201-588-6290
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Fax | 201-588-6059
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEMETRI E. DIMITRIADIS
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Credential | PT, DPT
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Telephone | 201-588-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 40QA01409300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA01409300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01409300
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01409300
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License Number State | NJ
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