Provider Demographics
NPI:1114121076
Name:REALINO, OLIVER JAY (DPT)
Entity type:Individual
Prefix:DR
First Name:OLIVER JAY
Middle Name:
Last Name:REALINO
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 1:1600 HARBOR BLVD APT 1601W
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6869
Mailing Address - Country:US
Mailing Address - Phone:917-915-8420
Mailing Address - Fax:
Practice Address - Street 1:7 W 22ND ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5142
Practice Address - Country:US
Practice Address - Phone:917-915-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0248252251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports