Provider Demographics
NPI:1134264732
Name:VRSALOVIC, DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VRSALOVIC
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 1:552 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1805
Mailing Address - Country:US
Mailing Address - Phone:973-509-0827
Mailing Address - Fax:973-509-0877
Practice Address - Street 1:552 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1805
Practice Address - Country:US
Practice Address - Phone:973-509-0827
Practice Address - Fax:973-509-0877
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01116800225100000X
NJ25MZ00084600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3695912OtherAETNA HMO PROVIDER #
NJ11314607OtherCAQH ID #
NJP3544996OtherOXFORD PROVIDER #
NJ7996424OtherAETNA PPO PROVIDER #
NJ2254500OtherUNITED HEALTH PROVIDER #
NJ7996424OtherAETNA PPO PROVIDER #