Healthcare Provider Details

I. General information

NPI: 1023155769
Provider Name (Legal Business Name): CAJITA AND ASSOCIATES PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 US HIGHWAY 46 SUITE 203
CLIFTON NJ
07013-2449
US

IV. Provider business mailing address

PO BOX 50205
STATEN ISLAND NY
10305-0205
US

V. Phone/Fax

Practice location:
  • Phone: 973-471-8110
  • Fax: 973-471-8111
Mailing address:
  • Phone: 973-471-8110
  • Fax: 973-471-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00804600
License Number StateNJ

VIII. Authorized Official

Name: SHELLA Z CAJITA
Title or Position: VICE PRESIDENT
Credential:
Phone: 973-471-8110