Provider Demographics
NPI:1528751336
Name:GAO-THORGERSEN, MEIJUN (LMT)
Entity type:Individual
Prefix:
First Name:MEIJUN
Middle Name:
Last Name:GAO-THORGERSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHERRY PL
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2525
Mailing Address - Country:US
Mailing Address - Phone:201-994-8992
Mailing Address - Fax:
Practice Address - Street 1:221 W GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1729
Practice Address - Country:US
Practice Address - Phone:845-694-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist