Provider Demographics
NPI:1043422009
Name:CEPP INNOVATION SPORTS & PHYSICAL REHAB CENTER
Entity Type:Organization
Organization Name:CEPP INNOVATION SPORTS & PHYSICAL REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OJUGO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-471-3500
Mailing Address - Street 1:1135 BROAD ST
Mailing Address - Street 2:FLR 3, SUITE 2
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3346
Mailing Address - Country:US
Mailing Address - Phone:973-471-3500
Mailing Address - Fax:973-471-3504
Practice Address - Street 1:1135 BROAD ST
Practice Address - Street 2:FLR 3, SUITE 2
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3346
Practice Address - Country:US
Practice Address - Phone:973-471-3500
Practice Address - Fax:973-471-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA104330261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7243404OtherAETNA ID
NJ11224882OtherCMS
NJ097388Medicare ID - Type Unspecified