Provider Demographics
NPI:1336219534
Name:VAN SCHALKWYK, JOHAN DIRK
Entity Type:Individual
Prefix:
First Name:JOHAN
Middle Name:DIRK
Last Name:VAN SCHALKWYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-0310
Mailing Address - Country:US
Mailing Address - Phone:908-806-2645
Mailing Address - Fax:908-806-5228
Practice Address - Street 1:112 HADDONTOWNE COURT
Practice Address - Street 2:SUITE 303
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3664
Practice Address - Country:US
Practice Address - Phone:856-354-5044
Practice Address - Fax:856-354-8133
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00824100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
037401QVQMedicare ID - Type Unspecified