Provider Demographics
NPI:1982826103
Name:ORDONA, ARCHIEVAL JOHN ROSLYN (PT)
Entity Type:Individual
Prefix:MR
First Name:ARCHIEVAL JOHN
Middle Name:ROSLYN
Last Name:ORDONA
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 1:4001 CRAWFORD CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3533
Mailing Address - Country:US
Mailing Address - Phone:908-265-5357
Mailing Address - Fax:
Practice Address - Street 1:118 PARSONAGE RD
Practice Address - Street 2:ROOSEVELT CARE CENTER
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837
Practice Address - Country:US
Practice Address - Phone:732-321-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01002100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist