Provider Demographics
NPI:1912958083
Name:ACHIEVE SPORTS MEDICINE & REHAB, LLC
Entity Type:Organization
Organization Name:ACHIEVE SPORTS MEDICINE & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-493-7440
Mailing Address - Street 1:491 EISENHOWER COURT
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-847-0881
Mailing Address - Fax:
Practice Address - Street 1:168 FRANKLIN TURNPIKE
Practice Address - Street 2:SUITE 103B
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463
Practice Address - Country:US
Practice Address - Phone:201-493-7440
Practice Address - Fax:201-493-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040815Medicare ID - Type Unspecified