Provider Demographics
NPI:1154104065
Name:FRAGANTE, PAUL VINCENT JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:VINCENT
Last Name:FRAGANTE
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-18 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1159
Mailing Address - Country:US
Mailing Address - Phone:201-310-8262
Mailing Address - Fax:
Practice Address - Street 1:253 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3739
Practice Address - Country:US
Practice Address - Phone:201-338-4053
Practice Address - Fax:201-338-4053
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02198700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist