=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477735330
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN B SILVARIA RN/PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2007
-----------------------------------------------------
Last Update Date | 12/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 RANCOCAS AVE
-----------------------------------------------------
City | DELANCO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08075-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-461-8601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 RANCOCAS AVE
-----------------------------------------------------
City | DELANCO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08075-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 40QB001095
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------