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General NPI Number Information
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NPI Number | 1144824392
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Entity Type | Individual
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Provider Name | GAIUS GHATTAS
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Gender | Male
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 6701 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1704
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Country | US
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Telephone | 732-979-7456
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Fax |
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Provider Business Mailing Address
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Address Line | 14 HEMLOCK DR
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City | PARLIN
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State | NJ
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Zip | 08859-1118
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Country | US
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Telephone | 732-979-7456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 303065
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01926500
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License Number State | NJ
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