Healthcare Provider Details

I. General information

NPI: 1477804748
Provider Name (Legal Business Name): JOSEPH B. PERAGINE PT,DPT, SCS, MSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 PRINCETON OVAL
FREEHOLD NJ
07728-5336
US

IV. Provider business mailing address

144 PRINCETON OVAL
FREEHOLD NJ
07728-5336
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2700
  • Fax: 732-294-2568
Mailing address:
  • Phone: 732-294-2700
  • Fax: 732-294-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA01285000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: