Pro Form Sports Medicine and Wellness Associates

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

25MA08835000 Issued in NJ

Legal business name

PRO FORM SPORTS MEDICINE AND WELLNESS ASSOCIATES

Practice address

201 Route 17
11TH Floor
Rutherford, NJ 07070-2574

Phone

(201) 549-8846

Fax

(201) 549-8839

NPI assigned

Dec 20, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Tae Keun Park, MD

Title

Partner

Phone

(646) 489-5640

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fabian Victor Morales, M.D.

  • Sports Medicine (Emergency Medicine) Physician
  • South Miami, FL
  • NPI 1477785145
  NPD (past)

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

{
    "created_epoch": "1292803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1235432972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 ROUTE 17",
            "address_2": "11TH FLOOR",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702574",
            "telephone_number": "201-549-8846",
            "fax_number": "201-549-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ROUTE 17",
            "address_2": "11TH FLOOR",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702574",
            "telephone_number": "201-549-8846",
            "fax_number": "201-549-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO FORM SPORTS MEDICINE AND WELLNESS ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-20",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "TAE KEUN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "646-489-5640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "NJ",
            "license": "25MA08835000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda R Pollifrone
• Jaroslaw S Pondo, MD
• Prestige Medical Associates LLC
• Prestinemd
• Prime Relief & Wellness
• Prodigy Medical Management
• Professional Occupational & Physical Therapy, PLLC
• Professional Occupational & Physical Therapy, PLLC
• Professional Orthopedic and Sports Physical Therapy of NJ, LLC
• Professional Orthopedic and Sports Physical Therapy of NJ, LLC

• Sports Medicine (Emergency Medicine) Physician in Rutherford, NJ
• Providers in Rutherford, NJ by specialty
• Sports Medicine (Emergency Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; 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.