Healthcare Provider Details

I. General information

NPI: 1164357539
Provider Name (Legal Business Name): JONATHAN DEVINCENZO-BARTLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WING DR STE 203
CEDAR KNOLLS NJ
07927-1024
US

IV. Provider business mailing address

326 MOUNTAIN AVE
NORTH CALDWELL NJ
07006-4014
US

V. Phone/Fax

Practice location:
  • Phone: 862-260-9656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02425600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: