Provider Demographics
NPI:1013334564
Name:CHOI, JERRY (DPT)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RARITAN AVE
Mailing Address - Street 2:STE 460
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2439
Mailing Address - Country:US
Mailing Address - Phone:732-543-1734
Mailing Address - Fax:732-342-7355
Practice Address - Street 1:85 RARITAN AVE
Practice Address - Street 2:STE 460
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2439
Practice Address - Country:US
Practice Address - Phone:732-543-1734
Practice Address - Fax:732-342-7355
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01544800225100000X
DEJ10003118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist