Provider Demographics
NPI:1568623536
Name:LITTLE FERRY SPORTS, SPINE & REHABILITATION CENTER
Entity Type:Organization
Organization Name:LITTLE FERRY SPORTS, SPINE & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-641-1600
Mailing Address - Street 1:167 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-2009
Mailing Address - Country:US
Mailing Address - Phone:201-641-1600
Mailing Address - Fax:201-807-0231
Practice Address - Street 1:167 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-2009
Practice Address - Country:US
Practice Address - Phone:201-641-1600
Practice Address - Fax:201-807-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00665500111N00000X
NJ40QA01102800225100000X
NJ40QA01032900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ127577Medicare PIN