| Organization Name: | PRO FORM SPORTS MEDICINE AND WELLNESS ASSOCIATES |
| NPI Number: | 1235432972 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAE KEUN PARK (PARTNER) |
| Mailing Address: | 201 Route 17 11th Floor Rutherford |
| State: | NJ US |
| Postal Code: | 070702574 |
| Phone Number: | 2015498846 |
| Fax Number: | 2015498839 |
| NPI Enumeration Date: | 12/20/2010 |
| NPI Last Update Date: | 12/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207PS0010X |
| License Number: | 25MA08835000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Emergency Medicine |
| Taxonomy Specialization: | Sports Medicine |
| Taxonomy Definition: | An emergency physician with special knowledge in sports medicine is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention and management of injury and illness. A sports medicine physician has knowledge and experience in the promotion of wellness and the role of exercise in promoting a healthy lifestyle. Knowledge of exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation and epidemiology is essential to the practice of sports medicine. |