Provider Demographics
NPI:1023624012
Name:TOTAL ACTIVCORE PC
Entity type:Organization
Organization Name:TOTAL ACTIVCORE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-872-5133
Mailing Address - Street 1:719 ROUTE 206 STE 104
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1529
Mailing Address - Country:US
Mailing Address - Phone:908-262-7401
Mailing Address - Fax:
Practice Address - Street 1:719 ROUTE 206 STE 104
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1529
Practice Address - Country:US
Practice Address - Phone:908-262-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty