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General NPI Number Information
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NPI Number | 1972923506
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Entity Type | Individual
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Provider Name | ISAAK GORELOV
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 6 NORTH CORPORATE DRIVE PUSH TO WALK
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City | RIVERDALE
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State | NJ
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Zip | 07457
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Country | US
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Telephone | 862-200-5848
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Fax | 862-200-5976
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Provider Business Mailing Address
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Address Line | 6 NORTH CORPORATE DRIVE PUSH TO WALK
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City | RIVERDALE
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State | NJ
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Zip | 07457
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Country | US
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Telephone | 862-200-5848
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Fax | 862-200-5976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 726999
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License Number State | NJ
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