Provider Demographics
NPI:1083017792
Name:MASSARO, JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MASSARO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6295
Mailing Address - Country:US
Mailing Address - Phone:201-666-9100
Mailing Address - Fax:
Practice Address - Street 1:645 WESTWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-5300
Practice Address - Country:US
Practice Address - Phone:201-666-9100
Practice Address - Fax:201-666-9100
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01580000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist