Provider Demographics
NPI:1407879828
Name:PAJARO, ABDIAS JOSE VALERA III
Entity Type:Individual
Prefix:
First Name:ABDIAS JOSE
Middle Name:VALERA
Last Name:PAJARO
Suffix:III
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 1:37 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1604
Mailing Address - Country:US
Mailing Address - Phone:732-738-1466
Mailing Address - Fax:
Practice Address - Street 1:7 CEDAR GROVE LN
Practice Address - Street 2:SUITE 35
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1331
Practice Address - Country:US
Practice Address - Phone:732-563-0070
Practice Address - Fax:732-563-0025
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00721400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090263T5WMedicare ID - Type Unspecified