Provider Demographics
NPI:1376713677
Name:NOVOGRODER, AZRIEL YACOV (PT)
Entity Type:Individual
Prefix:MR
First Name:AZRIEL
Middle Name:YACOV
Last Name:NOVOGRODER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:782 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2217
Mailing Address - Country:US
Mailing Address - Phone:201-836-6250
Mailing Address - Fax:201-836-6251
Practice Address - Street 1:1033 RIVER RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3119
Practice Address - Country:US
Practice Address - Phone:201-836-6250
Practice Address - Fax:201-836-6251
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40-QA00950000225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist