Healthcare Provider Details

I. General information

NPI: 1023655016
Provider Name (Legal Business Name): SCOTT JOSEPH KONINGSWOOD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 HAMBURG TPKE
WAYNE NJ
07470-2120
US

IV. Provider business mailing address

41 MOUNTAIN AVE
HAWTHORNE NJ
07506-3331
US

V. Phone/Fax

Practice location:
  • Phone: 862-203-1570
  • Fax: 862-229-9770
Mailing address:
  • Phone: 973-513-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01907700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: