Provider Demographics
NPI:1104106079
Name:SCRIFFIGNANO, ALEXANDRA ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ASHLEY
Last Name:SCRIFFIGNANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HATFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5305
Mailing Address - Country:US
Mailing Address - Phone:718-594-6366
Mailing Address - Fax:
Practice Address - Street 1:11 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3167
Practice Address - Country:US
Practice Address - Phone:973-887-0115
Practice Address - Fax:973-887-0775
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01407400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist