Provere Physical Therapy - Montclair, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROVERE PHYSICAL THERAPY - MONTCLAIR, LLC

Practice address

19 Elm St
Montclair, NJ 07042-3451

Phone

(201) 485-8971

NPI assigned

Mar 16, 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

(201) 485-8971

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1458086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1831550078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WYCKOFF AVE",
            "address_2": "UNIT 364",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 ELM ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423451",
            "telephone_number": "201-485-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVERE PHYSICAL THERAPY - MONTCLAIR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-16",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "HADDAD",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "201-485-8971"
    },
    "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": []
}

• Professional Occupational & Physical Therapy, PLLC
• Professional Orthopedic and Sports Physical Therapy of NJ, LLC
• Professional Orthopedic and Sports Physical Therapy of NJ, LLC
• Progressive Health Care, LLC
• Jennifer Prost, LCSW (DE), LSW (NJ)
• Pinky Pun, NP
• Crispino Punzalan, M.D.
• Ina Qema, MS,MFT
• Huma Quadir
• Dara Kristen Selene Querimit, PH.D.

• Physical Therapist in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.