Provider Demographics
NPI:1538126321
Name:DE JESUS, RAMON (PT)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
Last Name:DE JESUS
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 1:7 PARLIN DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2241
Mailing Address - Country:US
Mailing Address - Phone:732-238-8484
Mailing Address - Fax:732-238-3031
Practice Address - Street 1:329 CULVER RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2810
Practice Address - Country:US
Practice Address - Phone:732-438-3736
Practice Address - Fax:732-438-8486
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA010032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091349UCZMedicare ID - Type Unspecified