Provider Demographics
NPI:1841892759
Name:TALEM ACTIVE BODY AND SPINE THERAPY
Entity type:Organization
Organization Name:TALEM ACTIVE BODY AND SPINE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOGILAVAANI
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:848-219-4123
Mailing Address - Street 1:61 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2713
Mailing Address - Country:US
Mailing Address - Phone:848-219-4123
Mailing Address - Fax:
Practice Address - Street 1:61 WEXFORD DR
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2713
Practice Address - Country:US
Practice Address - Phone:848-219-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy