Pro Health Sports and Wellness Center Teaneck, LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

PRO HEALTH SPORTS AND WELLNESS CENTER TEANECK, LLC

Practice address

153 Fort Lee Rd
Teaneck, NJ 07666-3984

Phone

(551) 287-6500

Fax

(201) 836-2768

NPI assigned

Nov 4, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Barrett, DC

Title

Member

Phone

(973) 627-7888

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1124629415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 E MAIN ST",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342647",
            "telephone_number": "973-627-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 FORT LEE RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076663984",
            "telephone_number": "551-287-6500",
            "fax_number": "201-836-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO HEALTH SPORTS AND WELLNESS CENTER TEANECK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "BARRETT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "973-627-7888",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "demetriaglaab@denvillemedical.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "153 Fort Lee Rd",
            "city": "Teaneck",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076663984",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Teaneck, NJ
• Providers in Teaneck, NJ by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.