Healthcare Provider Details

I. General information

NPI: 1457867624
Provider Name (Legal Business Name): JONATHAN BERNARD HLASNEY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2017
Last Update Date: 12/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STERLING DR
PISCATAWAY NJ
08854-4911
US

IV. Provider business mailing address

57 ALLENS CORNER RD
FLEMINGTON NJ
08822-5622
US

V. Phone/Fax

Practice location:
  • Phone: 732-917-2900
  • Fax:
Mailing address:
  • Phone: 908-752-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00343200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: