Provider Demographics
NPI:1831222082
Name:PULVERENTI, ROBERT (DPT)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:PULVERENTI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-1703
Mailing Address - Country:US
Mailing Address - Phone:609-871-2913
Mailing Address - Fax:
Practice Address - Street 1:5101 N PARK DR
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4643
Practice Address - Country:US
Practice Address - Phone:856-665-8844
Practice Address - Fax:856-317-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00185400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist