Provider Demographics
NPI:1619900404
Name:CATLI, JAY ALLAN MARIANO (PT)
Entity Type:Individual
Prefix:
First Name:JAY ALLAN
Middle Name:MARIANO
Last Name:CATLI
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 1:3 EASTLICK RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3821
Mailing Address - Country:US
Mailing Address - Phone:732-985-4956
Mailing Address - Fax:
Practice Address - Street 1:1225 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2415
Practice Address - Country:US
Practice Address - Phone:718-477-2971
Practice Address - Fax:718-569-0704
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018533-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31Z21Medicare ID - Type UnspecifiedPHYSICAL THERAPIST