Provider Demographics
NPI:1457867624
Name:HLASNEY, JONATHAN BERNARD (PTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BERNARD
Last Name:HLASNEY
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 1:57 ALLENS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5622
Mailing Address - Country:US
Mailing Address - Phone:908-752-0934
Mailing Address - Fax:
Practice Address - Street 1:10 STERLING DR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4911
Practice Address - Country:US
Practice Address - Phone:732-917-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-23
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00343200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty