Provider Demographics
NPI:1154798171
Name:COGAVIN, CAROLINE HAYES (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HAYES
Last Name:COGAVIN
Suffix:
Gender:F
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 1:567 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1605
Mailing Address - Country:US
Mailing Address - Phone:908-461-5276
Mailing Address - Fax:
Practice Address - Street 1:608 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5170
Practice Address - Country:US
Practice Address - Phone:201-484-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01621000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist