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General NPI Number Information
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NPI Number | 1770805541
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Entity Type | Organization
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Legal Business Name | DE LA CERNA PT,PC
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 463 CLIFTON AVENUE
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City | CLIFTON
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State | NJ
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Zip | 07011
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Country | US
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Telephone | 973-546-2400
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Fax | 973-546-2441
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Provider Business Mailing Address
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Address Line | 98 MERKEL DRIVE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003
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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 | PT/PRESIDENT
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Name | JAMES DE LA CERNA
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Credential |
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Telephone | 973-752-8953
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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 | 40QA00903000
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License Number State | NJ
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