Provider Demographics
NPI:1205022191
Name:NG, GERRY SIP (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:GERRY
Middle Name:SIP
Last Name:NG
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2409
Mailing Address - Country:US
Mailing Address - Phone:201-385-4447
Mailing Address - Fax:
Practice Address - Street 1:95 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2409
Practice Address - Country:US
Practice Address - Phone:201-385-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy