Provider Demographics
NPI:1235204264
Name:FORCELLATI, FERDINANDO DAVID (PT MA PT GDMT)
Entity Type:Individual
Prefix:
First Name:FERDINANDO
Middle Name:DAVID
Last Name:FORCELLATI
Suffix:
Gender:M
Credentials:PT MA PT GDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 KENNEDY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5312
Mailing Address - Country:US
Mailing Address - Phone:201-861-4447
Mailing Address - Fax:201-943-5045
Practice Address - Street 1:9226 KENNEDY BOULEVARD 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-861-4447
Practice Address - Fax:201-861-3330
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00565100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043022Medicare PIN