Provider Demographics
NPI:1437524931
Name:JOA, DANTE
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:JOA
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 1:5300 BERGENLINE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5595
Mailing Address - Country:US
Mailing Address - Phone:201-854-9989
Mailing Address - Fax:201-854-6615
Practice Address - Street 1:5300 BERGENLINE AVE STE 1
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5595
Practice Address - Country:US
Practice Address - Phone:201-854-9989
Practice Address - Fax:201-854-6615
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00182200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist