Provider Demographics
NPI:1265583546
Name:SOLOTOFF, JUSTIN S (MSPT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:S
Last Name:SOLOTOFF
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3913
Mailing Address - Country:US
Mailing Address - Phone:973-662-1119
Mailing Address - Fax:
Practice Address - Street 1:271 US HIGHWAY 46
Practice Address - Street 2:SUITE G 106
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2440
Practice Address - Country:US
Practice Address - Phone:973-276-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJQA07528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist