Healthcare Provider Details

I. General information

NPI: 1033047287
Provider Name (Legal Business Name): GAGE MARCUS DEMELO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WORLDS FAIR DR # 2
SOMERSET NJ
08873-1369
US

IV. Provider business mailing address

2 WORLDS FAIR DR # 2
SOMERSET NJ
08873-1369
US

V. Phone/Fax

Practice location:
  • Phone: 732-537-0200
  • Fax: 732-564-9032
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02420600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: