Provider Demographics
NPI:1780196014
Name:SCARBOROUGH, JASMINE (DPT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2712
Mailing Address - Country:US
Mailing Address - Phone:973-661-1207
Mailing Address - Fax:973-661-1843
Practice Address - Street 1:49 CLAREMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4854
Practice Address - Country:US
Practice Address - Phone:973-680-8390
Practice Address - Fax:973-680-6391
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01742300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist