Organization
ACTIVCORE HEALTH NETWORK LLC
Active
Other names
ACTIVCORE
Organization subpart
No
Provider details
NPI number
Authorized official
IAN KORNBLUTH PT, MPT (PRESIDENT)
(800) 455-8982
Entity
Organization
Contact information
Practice address
800 BUNN DR STE 102, PRINCETON, NJ 08540-1968
(800) 455-8982
(609) 644-3817
Mailing address
800 BUNN DR STE 102, PRINCETON, NJ 08540-1968
(800) 455-8982
(609) 644-3817
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
413846
MEDICARE PTAN
NJ
Enumeration date
06/05/2014
Last updated
09/20/2020
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