Provere Physical Therapy - Springfield

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROVERE PHYSICAL THERAPY - SPRINGFIELD

Practice address

901 Mountain Ave
Springfield, NJ 07081-3414

Phone

(732) 221-7617

NPI assigned

Aug 31, 2016

Organization subpart

No

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

Authorized official

Name

Cedric Haddad

Title

Ceo

Phone

(732) 221-7617

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1821544693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WYCKOFF AVE",
            "address_2": "PMB 395",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "07481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MOUNTAIN AVE",
            "city": "SPRINGFIELD",
            "state": "NJ",
            "postal_code": "070813414",
            "telephone_number": "732-221-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVERE PHYSICAL THERAPY - SPRINGFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "HADDAD",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "732-221-7617"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; 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.