Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pro Form Sports Medicine and Wellness Associates

Organization Sports Medicine (Emergency Medicine) Physician · NPI 1235432972

Pro Form Sports Medicine and Wellness Associates is a Sports Medicine (Emergency Medicine) Physician in Rutherford, New Jersey. Licensed in New Jersey. Registered with an NPI since 2010.

Licensed in
NJ
In the registry since
2010

Practice location Address checks out

201 Route 17 11th Fl
Rutherford, NJ 07070-2574
Phone: (201) 549-8846
Fax: (201) 549-8839
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Emergency Medicine) Physician (primary) Taxonomy 207PS0010X · Licence 25MA08835000 (NJ)

Record details

NPI number1235432972
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tae Keun Park — Partner · (646) 489-5640
NPI enumeratedDecember 20, 2010
Last updated in NPPESDecember 20, 2010
Mailing address201 Route 17, 11th Floor, Rutherford, NJ 07070-2574

Other providers in Rutherford