Provider Demographics
NPI:1811720014
Name:MAYER, PATRICK ANTHONY (DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTHONY
Last Name:MAYER
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 1:54 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2134
Mailing Address - Country:US
Mailing Address - Phone:973-896-5224
Mailing Address - Fax:
Practice Address - Street 1:69 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1426
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02272100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist