Provider Demographics
NPI:1962747600
Name:PROCORE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PROCORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFAELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGONIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-464-6356
Mailing Address - Street 1:14 ALLISTER CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1760
Mailing Address - Country:US
Mailing Address - Phone:973-464-6356
Mailing Address - Fax:
Practice Address - Street 1:2651 ROUTE 10 EAST
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-464-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy