Individual
PATRA VONGSOASUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 PARK AVE, FLORHAM PARK, NJ 07932-1049
(973) 404-9840
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
283X00000X
Rehabilitation Hospital
46TR00670500
NJ
Other
Enumeration date
12/01/2014
Last updated
03/02/2022
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