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General NPI Number Information
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NPI Number | 1568910206
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Entity Type | Organization
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Legal Business Name | PROVERE PHYSICAL THERAPY - EAST HANOVER
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 50 WILLIAMS PKWY UNIT D
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City | EAST HANOVER
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State | NJ
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Zip | 07936-2114
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Country | US
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Telephone | 973-233-7148
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Fax |
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Provider Business Mailing Address
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Address Line | 637 WYCKOFF AVE PMB 395
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City | WYCKOFF
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State | NJ
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Zip | 07481-1438
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | CEDRIC HADDAD
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Credential | PT, DPT, CSCS
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Telephone | 732-221-7617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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