Provider Demographics
NPI:1710285986
Name:THERA-PEDE
Entity Type:Organization
Organization Name:THERA-PEDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-739-7027
Mailing Address - Street 1:PO BOX 8348
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663
Mailing Address - Country:US
Mailing Address - Phone:201-739-7027
Mailing Address - Fax:201-254-9915
Practice Address - Street 1:8-14 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5733
Practice Address - Country:US
Practice Address - Phone:201-739-7027
Practice Address - Fax:201-254-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00771000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health