Provider Demographics
| NPI: | 1770051559 |
|---|---|
| Name: | POPS THERAPEUTICS,LLC |
| Entity type: | Organization |
| Organization Name: | POPS THERAPEUTICS,LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JOHN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MAC EVOY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 973-271-5802 |
| Mailing Address - Street 1: | 111 OLD CHESTER RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ESSEX FELLS |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 07021-1625 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 973-271-5802 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 60 POMPTON AVE REAR |
| Practice Address - Street 2: | |
| Practice Address - City: | VERONA |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 07044-2946 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 973-271-5802 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2018-11-09 |
| Last Update Date: | 2018-11-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 224ZE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Environmental Modification | Group - Multi-Specialty |
| No | 224ZF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Feeding, Eating & Swallowing | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251H1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors | Group - Multi-Specialty |
