MEDICARE: NICHOLAS SCAGLIONE LICENSED PTA

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
1	225200000X	Physical Therapy Assistant	40QB00289600	NJ

General Provider Information

NPI Number	:	1902541501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SCAGLIONE LICENSED PTA

Provider Business Mailing Address
First Line	:	1253 VALLEY RD APT A
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7978
Country	:	US
Telephone Number	:	201-744-5740
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 PINES LAKE DR W
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6107
Country	:	US
Telephone Number	:	201-744-5740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	11/18/2025

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Directions to “ NICHOLAS SCAGLIONE LICENSED PTA” Practice Location

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