Provider Demographics
NPI:1124852496
Name:TARAKJI, MOHAMED WYELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:WYELL
Last Name:TARAKJI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NETCONG HTS APT 6
Mailing Address - Street 2:
Mailing Address - City:NETCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07857-1710
Mailing Address - Country:US
Mailing Address - Phone:973-580-8643
Mailing Address - Fax:
Practice Address - Street 1:280 NEWTON SPARTA RD STE 8
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2775
Practice Address - Country:US
Practice Address - Phone:973-494-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02284500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist