Provider Demographics
NPI:1366682601
Name:HALEDON PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:HALEDON PHYSICAL THERAPY & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALQUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-689-6112
Mailing Address - Street 1:401 HALEDON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1570
Mailing Address - Country:US
Mailing Address - Phone:973-689-6112
Mailing Address - Fax:973-689-6114
Practice Address - Street 1:401 HALEDON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1570
Practice Address - Country:US
Practice Address - Phone:973-689-6112
Practice Address - Fax:973-689-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0099400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty