Healthcare Provider Details

I. General information

NPI: 1902858236
Provider Name (Legal Business Name): ROVY SALENGA SAMSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SCENIC DR
FREEHOLD NJ
07728-5210
US

IV. Provider business mailing address

91 WOOD DUCK CT
FREEHOLD NJ
07728-9522
US

V. Phone/Fax

Practice location:
  • Phone: 732-863-6900
  • Fax:
Mailing address:
  • Phone: 732-677-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: