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Organization

JAG PEDIATRIC THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SANDY BOULES (ADMINISTRATIVE DIRECTOR)
(973) 477-6045
Entity
Organization

Contact information

Practice address
622 EAGLE ROCK AVE, WEST ORANGE, NJ 07052-2994
(973) 669-0072
Mailing address
622 EAGLE ROCK AVE, WEST ORANGE, NJ 07052-2994
(973) 669-0072

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary

Other

Enumeration date
01/29/2013
Last updated
01/29/2013
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