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NPI Code Detail

MEDICARE: JAMES JOSEPH VAN DIEN JR. MSPT

MEDICARE:   JAMES JOSEPH VAN DIEN JR. MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA01259400NJ

General Provider Information

NPI Number : 1225225303
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES JOSEPH VAN DIEN JR. MSPT
Provider Business Mailing Address
First Line : 170 SCHUYLER AVE
Second Line : SUITE 3
City : NORTH ARLINGTON
State : NJ
Zip : 07031-5412
Country : US
Telephone Number : 201-991-3800
Fax Number : 201-991-4800
Provider Business Practice Location Address
First Line : 170 SCHUYLER AVE
Second Line : SUITE 3
City : NORTH ARLINGTON
State : NJ
Zip : 07031-5412
Country : US
Telephone Number : 201-991-3800
Fax Number : 201-991-4800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2007
Last Update Date : 01/02/2013

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