Healthcare Provider Details

I. General information

NPI: 1710468681
Provider Name (Legal Business Name): JOSHUA SOLOMON ITZKOWITZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 GITI RD
LAKEWOOD NJ
08701-5630
US

IV. Provider business mailing address

17 GITI RD
LAKEWOOD NJ
08701-5630
US

V. Phone/Fax

Practice location:
  • Phone: 347-228-7932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: