Provider Demographics
NPI:1760784177
Name:STROSSER, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:STROSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ANDERSON ST
Mailing Address - Street 2:APT. D
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1818
Mailing Address - Country:US
Mailing Address - Phone:908-922-6848
Mailing Address - Fax:
Practice Address - Street 1:27 ANDERSON ST
Practice Address - Street 2:APT. D
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1818
Practice Address - Country:US
Practice Address - Phone:908-922-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4OBQ00260400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QB00260400OtherPTA LISCENSE