Provider Demographics
NPI:1609310317
Name:NOLL, JAMES G (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:NOLL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:243 SPARTA AVE STE 2
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1143
Practice Address - Country:US
Practice Address - Phone:973-512-3180
Practice Address - Fax:973-512-3280
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037966-1225100000X
HIPT-4278225100000X
NCP15747225100000X
NJ40QA01992700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist