Provider Demographics
NPI:1679785950
Name:ALCONABA, JOSE CARLOS JULIANO (PT)
Entity Type:Individual
Prefix:
First Name:JOSE CARLOS
Middle Name:JULIANO
Last Name:ALCONABA
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 1:2023 RIDINGS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8737
Mailing Address - Country:US
Mailing Address - Phone:856-582-4665
Mailing Address - Fax:
Practice Address - Street 1:2023 RIDINGS DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8737
Practice Address - Country:US
Practice Address - Phone:856-582-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QAOO673900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist