Organization
EARLY START PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN OVALLES (PRESIDENT)
(917) 292-7409
Entity
Organization
Contact information
Practice address
69 ALEXANDER AVE, MONTCLAIR, NJ 07043
(917) 292-7409
Mailing address
69 ALEXANDER AVE, MONTCLAIR, NJ 07043-2629
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
023351
NY
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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