Provider Demographics
NPI:1467462044
Name:MANDANAS, JORGE JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:MANDANAS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 US HIGHWAY 46 STE 9
Mailing Address - Street 2:#313
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4046
Mailing Address - Country:US
Mailing Address - Phone:973-586-4800
Mailing Address - Fax:973-586-3559
Practice Address - Street 1:179-9 ROUTE 46 WEST
Practice Address - Street 2:#313
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866
Practice Address - Country:US
Practice Address - Phone:973-586-4800
Practice Address - Fax:973-586-3559
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00655700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035858Medicare ID - Type Unspecified