Provider Demographics
NPI:1407256704
Name:CORIDDI, CAITLIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CORIDDI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2821
Mailing Address - Country:US
Mailing Address - Phone:201-919-5102
Mailing Address - Fax:
Practice Address - Street 1:345 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2339
Practice Address - Country:US
Practice Address - Phone:973-377-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01567700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ368977YXU4Medicare Oscar/Certification