Provider Demographics
NPI:1558322990
Name:YORK, FREDERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:YORK
Suffix:
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 1:1140 ROUTE 130
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1107
Mailing Address - Country:US
Mailing Address - Phone:609-890-3211
Mailing Address - Fax:609-890-3319
Practice Address - Street 1:1140 ROUTE 130
Practice Address - Street 2:SUITE 1
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1107
Practice Address - Country:US
Practice Address - Phone:609-890-3211
Practice Address - Fax:609-890-3319
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00318700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ033154VDEMedicare ID - Type Unspecified