Provider Demographics
NPI:1407368426
Name:JOSEPH CHORBA JR TLC ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:JOSEPH CHORBA JR TLC ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHORBA
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPO
Authorized Official - Phone:609-379-6453
Mailing Address - Street 1:163 ROUTE 130 STE D
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2248
Mailing Address - Country:US
Mailing Address - Phone:609-379-6453
Mailing Address - Fax:609-379-6754
Practice Address - Street 1:163 ROUTE 130 STE D
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2248
Practice Address - Country:US
Practice Address - Phone:609-379-6453
Practice Address - Fax:609-379-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00006900222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty