Jag Pediatric Therapy

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

JAG PEDIATRIC THERAPY

Practice address

622 Eagle Rock Ave
West Orange, NJ 07052-2994

Phone

(973) 669-0072

NPI assigned

Jan 29, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandy Boules

Title

Administrative Director

Phone

(973) 477-6045

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359417600000",
    "number": "1013255827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522994",
            "telephone_number": "973-669-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522994",
            "telephone_number": "973-669-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAG PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2013-01-29",
        "status": "A",
        "authorized_official_last_name": "BOULES",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "973-477-6045"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Gold Surgical Appliances, Inc. (AlliedOP)
• Marianne Jacob
• Sonia Jacob
• Tess Jacob, M.D
• Fred Martin Jacobs, MD JD
• Jag-One Physical Therapy, LLC
• Harsh Jain, DO
• James a Valenza MD PA
• James M. Lee Jr MD PA (Orange Orthopaedic Associatees)
• James McCarcum Lee MD PA

• Physical Therapy Clinic/Center in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Physical Therapy Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.