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General NPI Number Information
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NPI Number | 1407368426
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Entity Type | Organization
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Legal Business Name | JOSEPH CHORBA JR TLC ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 163 ROUTE 130 STE D
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2248
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Country | US
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Telephone | 609-379-6453
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Fax | 609-379-6754
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Provider Business Mailing Address
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Address Line | 163 ROUTE 130 STE D
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2248
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Country | US
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Telephone | 609-379-6453
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Fax | 609-379-6754
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Authorized Official
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Title or Position | CEO, PRESIDENT
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Name | JOSEPH CHORBA JR.
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Credential | LPO
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Telephone | 609-379-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | 45PO00006900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 45PO00006900
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License Number State | NJ
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