Provider Demographics
NPI:1841244829
Name:PARAMUS MEDICAL & SPORTS REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:PARAMUS MEDICAL & SPORTS REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCHIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-225-1511
Mailing Address - Street 1:205 ROBIN RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1449
Mailing Address - Country:US
Mailing Address - Phone:201-225-1511
Mailing Address - Fax:201-225-9731
Practice Address - Street 1:205 ROBIN RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1449
Practice Address - Country:US
Practice Address - Phone:201-225-1511
Practice Address - Fax:201-225-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00183600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========AOtherBLUE CROSS & BLUE SHIELD
NJ=========AOtherBLUE CROSS & BLUE SHIELD