Provider Demographics
NPI:1164848206
Name:MAGDIELI, GAD (PT)
Entity Type:Individual
Prefix:
First Name:GAD
Middle Name:
Last Name:MAGDIELI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2808
Mailing Address - Country:US
Mailing Address - Phone:908-389-9100
Mailing Address - Fax:908-389-9101
Practice Address - Street 1:1111 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2808
Practice Address - Country:US
Practice Address - Phone:908-389-9100
Practice Address - Fax:908-389-9101
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00146000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist