Provider Demographics
NPI:1326699786
Name:JESKEVICIUS, DEIVIDAS
Entity Type:Individual
Prefix:
First Name:DEIVIDAS
Middle Name:
Last Name:JESKEVICIUS
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 1:41 WALTER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3419
Mailing Address - Country:US
Mailing Address - Phone:732-691-6907
Mailing Address - Fax:
Practice Address - Street 1:212 NJ-94 UNIT 2G & 2H
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462
Practice Address - Country:US
Practice Address - Phone:973-209-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00888700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist