Provider Demographics
NPI:1659505022
Name:NAGATSUKA, JOHN M (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:NAGATSUKA
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 1:106 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3404
Mailing Address - Country:US
Mailing Address - Phone:201-679-6627
Mailing Address - Fax:
Practice Address - Street 1:106 ERIE ST
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3404
Practice Address - Country:US
Practice Address - Phone:201-679-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01284600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ155857ZGJ0Medicare PIN