Provider Demographics
NPI:1902921638
Name:SUGARMAN, KELLY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENVIL
Mailing Address - State:NJ
Mailing Address - Zip Code:07847-2502
Mailing Address - Country:US
Mailing Address - Phone:973-927-8588
Mailing Address - Fax:
Practice Address - Street 1:84 COLD HILL RD
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-2021
Practice Address - Country:US
Practice Address - Phone:973-543-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00198800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant