Provider Demographics
NPI:1326338781
Name:THERAPRO MEDICAL AND SURGICAL REHABILITATION, P.C.
Entity Type:Organization
Organization Name:THERAPRO MEDICAL AND SURGICAL REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-869-2707
Mailing Address - Street 1:9225 KENNEDY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5361
Mailing Address - Country:US
Mailing Address - Phone:201-869-2707
Mailing Address - Fax:
Practice Address - Street 1:9225 KENNEDY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5361
Practice Address - Country:US
Practice Address - Phone:201-869-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08433600207LP2900X, 207X00000X, 2084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty