Provider Demographics
NPI:1902541501
Name:SCAGLIONE, NICHOLAS (LICENSED PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SCAGLIONE
Suffix:
Gender:M
Credentials:LICENSED PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 VALLEY RD APT A
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7978
Mailing Address - Country:US
Mailing Address - Phone:201-744-5740
Mailing Address - Fax:
Practice Address - Street 1:1253 VALLEY RD APT A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7978
Practice Address - Country:US
Practice Address - Phone:201-744-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00289600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant