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General NPI Number Information
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NPI Number | 1093243297
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Entity Type | Organization
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Legal Business Name | VISION QUEST PT
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 52 E MADISON AVE STE B
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City | DUMONT
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State | NJ
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Zip | 07628-2437
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Country | US
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Telephone | 201-614-4625
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Fax |
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Provider Business Mailing Address
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Address Line | 106 ERIE ST
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City | DUMONT
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State | NJ
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Zip | 07628-3404
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Country | US
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Telephone | 201-679-6627
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Fax |
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Authorized Official
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Title or Position | OWNER/PT
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Name | DR. JOHN NAGATSUKA
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Credential | DPT
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Telephone | 201-614-4625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA0
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License Number State |
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