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NPI Code Detail

MEDICARE: THERAPRO-CORF, LLC

MEDICARE: THERAPRO-CORF, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number : 1043497571
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERAPRO-CORF, LLC
Provider Business Mailing Address
First Line : 9225 KENNEDY BLVD
Second Line :
City : NORTH BERGEN
State : NJ
Zip : 07047-5361
Country : US
Telephone Number : 201-869-2701
Fax Number : 201-869-2717
Provider Business Practice Location Address
First Line : 9225 KENNEDY BLVD
Second Line :
City : NORTH BERGEN
State : NJ
Zip : 07047-5361
Country : US
Telephone Number : 201-869-2701
Fax Number : 201-869-2717
Authorized Official
Title or Position : CEO
Name : DR. RAVI TIKOO
Credential :
Telephone Number : 917-536-8940
Provider Enumeration Date : 01/28/2008
Last Update Date : 04/04/2013

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Directions to “THERAPRO-CORF, LLC ” Practice Location

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