Provider Demographics
NPI:1538374657
Name:MASCIANGELO, JACQUELYN N (MPT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:N
Last Name:MASCIANGELO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SUMMIT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2830
Mailing Address - Country:US
Mailing Address - Phone:908-219-4643
Mailing Address - Fax:
Practice Address - Street 1:30 VREELAND RD
Practice Address - Street 2:BUILDING A SUITE 110
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1904
Practice Address - Country:US
Practice Address - Phone:973-660-1000
Practice Address - Fax:973-660-1008
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01138500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist