Provider Demographics
NPI:1073664959
Name:GALAROSA, MARVIN PAUL (PT)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:PAUL
Last Name:GALAROSA
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 1:31 SPRUCE COURT
Mailing Address - Street 2:# 120
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014
Mailing Address - Country:US
Mailing Address - Phone:973-246-6325
Mailing Address - Fax:973-772-3930
Practice Address - Street 1:283 PIAGET STREET
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-772-3930
Practice Address - Fax:973-772-1498
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01006700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist