Provider Demographics
NPI:1124544259
Name:DERING, CONNOR JAMES
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JAMES
Last Name:DERING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PARK AVE APT 1614
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-7116
Mailing Address - Country:US
Mailing Address - Phone:732-977-1756
Mailing Address - Fax:
Practice Address - Street 1:1 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3649
Practice Address - Country:US
Practice Address - Phone:973-746-2424
Practice Address - Fax:973-746-5030
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01739600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist