Provider Demographics
NPI:1952791618
Name:COR GROUP
Entity Type:Organization
Organization Name:COR GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELYSA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:201-218-8772
Mailing Address - Street 1:294 HARRINGTON AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624
Mailing Address - Country:US
Mailing Address - Phone:201-564-7331
Mailing Address - Fax:
Practice Address - Street 1:294 HARRINGTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1912
Practice Address - Country:US
Practice Address - Phone:201-564-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR004500251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health