Provider Demographics
NPI:1841210945
Name:DILAURI, JONATHAN (MPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:DILAURI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2569
Mailing Address - Country:US
Mailing Address - Phone:973-660-1000
Mailing Address - Fax:
Practice Address - Street 1:30 VREELAND RD
Practice Address - Street 2:BUILDING A SUITE110
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1904
Practice Address - Country:US
Practice Address - Phone:973-660-1000
Practice Address - Fax:973-660-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00867400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist