Provider Demographics
NPI:1952504730
Name:GRODBERG, ARLENE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:
Last Name:GRODBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PRISCILLA LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2314
Mailing Address - Country:US
Mailing Address - Phone:201-567-6189
Mailing Address - Fax:201-567-6189
Practice Address - Street 1:16 PRISCILLA LN
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2314
Practice Address - Country:US
Practice Address - Phone:201-567-6189
Practice Address - Fax:201-567-6189
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00254100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088828Medicare UPIN