Healthcare Provider Details

I. General information

NPI: 1265016661
Provider Name (Legal Business Name): PATRICK JONATHAN OLOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 W PARKWAY
POMPTON PLAINS NJ
07444-1029
US

IV. Provider business mailing address

242 W PARKWAY
POMPTON PLAINS NJ
07444-1029
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-0717
  • Fax:
Mailing address:
  • Phone: 973-831-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01952400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: