Provider Demographics
NPI:1629735584
Name:GERALDIZO, JAMES EDWARD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES EDWARD
Middle Name:
Last Name:GERALDIZO
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 1:56 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1851
Mailing Address - Country:US
Mailing Address - Phone:732-912-9536
Mailing Address - Fax:
Practice Address - Street 1:717 N BEERS ST STE 1E
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1525
Practice Address - Country:US
Practice Address - Phone:219-273-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02060200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist