MEDICARE: JENNIFER NEGLIA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00448700	NJ

General Provider Information

NPI Number	:	1942329172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NEGLIA PT

Provider Business Mailing Address
First Line	:	3 E LOGAN RD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2611
Country	:	US
Telephone Number	:	973-252-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 E LOGAN RD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2611
Country	:	US
Telephone Number	:	973-252-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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