Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 40QA01285000 | NJ |
NPI | 1477804748 |
---|---|
Provider Name | Joseph B. Peragine |
First Address | Freehold, NJ 07728-5336 |
Second Address | Freehold, NJ 07728-5336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2012 |
Last Update Date | 27/09/2012 |