Basic Information
| Provider Information | |||||||||
| NPI: | 1124544259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERING | ||||||||
| FirstName: | CONNOR | ||||||||
| MiddleName: | JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 PARK AVE APT 1614 | ||||||||
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| City: | HOBOKEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070307116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329771756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GREENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070423649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737462424 | ||||||||
| FaxNumber: | 9737465030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 08/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01739600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.