Healthcare Provider Details

I. General information

NPI: 1619433463
Provider Name (Legal Business Name): PETER J CARFAGNO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HIDDEN VALLEY CT
HOWELL NJ
07731-2972
US

IV. Provider business mailing address

1 HIDDEN VALLEY CT
HOWELL NJ
07731-2972
US

V. Phone/Fax

Practice location:
  • Phone: 610-217-9905
  • Fax:
Mailing address:
  • Phone: 610-217-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02303500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00268300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: