Provider Demographics
NPI:1134474018
Name:HADDAD, CEDRIC (DPT)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4900
Mailing Address - Country:US
Mailing Address - Phone:732-842-4198
Mailing Address - Fax:
Practice Address - Street 1:656 SHREWSBURY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4900
Practice Address - Country:US
Practice Address - Phone:732-842-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1114250057Medicare NSC