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General NPI Number Information
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NPI Number | 1962747600
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Entity Type | Organization
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Legal Business Name | PROCORE PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 2651 ROUTE 10 EAST
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City | MORRIS PLAINS
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State | NJ
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Zip | 07950
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Country | US
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Telephone | 973-464-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 14 ALLISTER CT
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City | LINCOLN PARK
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State | NJ
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Zip | 07035-1760
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Country | US
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Telephone | 973-464-6356
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | DR. RAFFAELE LAGONIGRO
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Credential | DPT
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Telephone | 973-464-6356
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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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