Provider Demographics
NPI:1235730847
Name:LANCASTER, JOHN MALE (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MALE
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIRKPATRICK ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-4070
Mailing Address - Country:US
Mailing Address - Phone:732-545-0494
Mailing Address - Fax:
Practice Address - Street 1:100 KIRKPATRICK STREET
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-4070
Practice Address - Country:US
Practice Address - Phone:732-545-0494
Practice Address - Fax:732-545-0498
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00297900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant