Provider Demographics
NPI:1144321142
Name:IGNACIO, JOHN ROMMER (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROMMER
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1709
Mailing Address - Country:US
Mailing Address - Phone:646-339-5951
Mailing Address - Fax:
Practice Address - Street 1:25 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1709
Practice Address - Country:US
Practice Address - Phone:646-339-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01051300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094460Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
NJ067985RSTMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE