Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Pro Form Sports Medicine and Wellness Associates

Sports Medicine (Emergency Medicine) Physician in Rutherford, NJ · enumerated 2010 · authorized official Tae Keun Park, Partner.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1235432972

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Registry record

Entity type Organization (Type 2)

Legal business name Pro Form Sports Medicine and Wellness Associates

Practice address 201 Route 17, 11th Floor, Rutherford, NJ, 07070

Phone (201) 549-8846

Fax (201) 549-8839

Enumeration date Dec 20, 2010

Last updated in NPPES Dec 20, 2010

Taxonomy & classification

207PS0010X Sports Medicine (Emergency Medicine) Physician Allopathic & Osteopathic Physicians · License 25MA08835000 (NJ) Primary

Authorized official

Name Tae Keun Park

Title Partner

Phone (646) 489-5640

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

What is the NPI number for Pro Form Sports Medicine and Wellness Associates?

The NPI for Pro Form Sports Medicine and Wellness Associates is 1235432972, a Type 2 (organization) record in the CMS NPPES registry.

Who is the authorized official for Pro Form Sports Medicine and Wellness Associates?

NPPES lists Tae Keun Park (Partner) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-12-20.