Provider Demographics
NPI:1497099543
Name:GREGORIO, REGINALDO POMER (LPT)
Entity Type:Individual
Prefix:MR
First Name:REGINALDO
Middle Name:POMER
Last Name:GREGORIO
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4678
Mailing Address - Country:US
Mailing Address - Phone:609-748-5627
Mailing Address - Fax:
Practice Address - Street 1:119 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4678
Practice Address - Country:US
Practice Address - Phone:609-748-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01123700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ80995Medicaid