Provider Demographics
NPI:1114185329
Name:GO, ROBERTO SABELLANO JR (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:SABELLANO
Last Name:GO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:265 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-1603
Mailing Address - Country:US
Mailing Address - Phone:973-299-4443
Mailing Address - Fax:973-299-4443
Practice Address - Street 1:6 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1883
Practice Address - Country:US
Practice Address - Phone:973-966-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00973500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist