Provider Demographics
NPI:1144561416
Name:JOINTKARE PHYSICAL THERAPY AND SERVICES PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:JOINTKARE PHYSICAL THERAPY AND SERVICES PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ORIO
Authorized Official - Last Name:GONZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-428-1208
Mailing Address - Street 1:731 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-1904
Mailing Address - Country:US
Mailing Address - Phone:917-428-1208
Mailing Address - Fax:
Practice Address - Street 1:14-25 PLAZA RD
Practice Address - Street 2:S 3-1
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3546
Practice Address - Country:US
Practice Address - Phone:201-797-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400554151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty