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General NPI Number Information
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NPI Number | 1659784767
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Entity Type | Organization
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Legal Business Name | ACTIVCORE HEALTH NETWORK LLC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 09/20/2020
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Provider Practice Location Address
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Address Line | 800 BUNN DR STE 102
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City | PRINCETON
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State | NJ
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Zip | 08540-1968
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Country | US
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Telephone | 800-455-8982
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Fax | 609-644-3817
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Provider Business Mailing Address
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Address Line | 800 BUNN DR STE 102
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City | PRINCETON
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State | NJ
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Zip | 08540-1968
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Country | US
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Telephone | 800-455-8982
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Fax | 609-644-3817
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Authorized Official
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Title or Position | PRESIDENT
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Name | IAN KORNBLUTH
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Credential | PT, MPT
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Telephone | 800-455-8982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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