Provider Demographics
NPI:1245420843
Name:BUDDHA, RAZAK A (OTR/L)
Entity Type:Individual
Prefix:
First Name:RAZAK
Middle Name:A
Last Name:BUDDHA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5604
Mailing Address - Country:US
Mailing Address - Phone:201-837-3512
Mailing Address - Fax:
Practice Address - Street 1:801 KINGS HWY N
Practice Address - Street 2:FOX REHABILITATION SERVICES
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1513
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00222800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist