MEDICARE: THE INJURY PREVENTER L.L.C.

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1508566795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INJURY PREVENTER L.L.C.

Provider Business Mailing Address
First Line	:	86 CRESCENT AVE
Second Line	:
City	:	CLIFFSIDE PARK
State	:	NJ
Zip	:	07010-3046
Country	:	US
Telephone Number	:	201-970-7574
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 CRESCENT AVE
Second Line	:
City	:	CLIFFSIDE PARK
State	:	NJ
Zip	:	07010-3046
Country	:	US
Telephone Number	:	201-970-7574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COSIMO CARRIERI
Credential	:	DPT
Telephone Number	:	201-970-7574

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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