Provider Demographics
NPI:1982854733
Name:PRIMERANO, JERALYN
Entity Type:Individual
Prefix:MRS
First Name:JERALYN
Middle Name:
Last Name:PRIMERANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 HIGHWAY 35
Mailing Address - Street 2:UNION SQUARE PLAZA OFFICE COMMONS
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5066
Mailing Address - Country:US
Mailing Address - Phone:732-219-5700
Mailing Address - Fax:732-219-5703
Practice Address - Street 1:1016 HIGHWAY 34
Practice Address - Street 2:PINE CREST PLAZA, BLDG. 9
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3476
Practice Address - Country:US
Practice Address - Phone:732-219-5700
Practice Address - Fax:732-219-5703
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00549100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist