Provider Demographics
NPI:1821036955
Name:SKELLY, JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:SKELLY
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 1:22 DEPEW AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3891
Mailing Address - Country:US
Mailing Address - Phone:845-480-5963
Mailing Address - Fax:
Practice Address - Street 1:445 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1507
Practice Address - Country:US
Practice Address - Phone:201-444-4991
Practice Address - Fax:201-444-2593
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00202900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist