Healthcare Provider Details

I. General information

NPI: 1457082612
Provider Name (Legal Business Name): ALEXANDER JAMES SKOOG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 ROUTE 34
MANASQUAN NJ
08736-1444
US

IV. Provider business mailing address

2315 ROUTE 34
MANASQUAN NJ
08736-1444
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-0404
  • Fax: 732-449-4271
Mailing address:
  • Phone: 732-974-0404
  • Fax: 732-449-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02094300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: