Provider Demographics
NPI:1518415223
Name:DEFEO, CARMINE J (DPT)
Entity Type:Individual
Prefix:
First Name:CARMINE
Middle Name:J
Last Name:DEFEO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-4905
Mailing Address - Country:US
Mailing Address - Phone:908-756-2424
Mailing Address - Fax:908-546-7978
Practice Address - Street 1:459 WATCHUNG AVE
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-4945
Practice Address - Country:US
Practice Address - Phone:908-756-2424
Practice Address - Fax:908-756-2447
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01680300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist