Basic Information
| Provider Information | |||||||||
| NPI: | 1164873824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOZADA | ||||||||
| FirstName: | JON JOSEPH | ||||||||
| MiddleName: | PASTRANO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 FRANKLIN AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447770910 | ||||||||
| FaxNumber: | 2015600712 | ||||||||
| Practice Location | |||||||||
| Address1: | 784 FRANKLIN AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447770910 | ||||||||
| FaxNumber: | 2015600712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2016 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA01610800 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.