Basic Information
| Provider Information | |||||||||
| NPI: | 1598273583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILSON | ||||||||
| FirstName: | TESSA | ||||||||
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| Credential: | DPT, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 RIDGEDALE AVE | ||||||||
| Address2: | |||||||||
| City: | FLORHAM PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079321743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173482474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 CEDAR KNOLLS RD | ||||||||
| Address2: | |||||||||
| City: | CEDAR KNOLLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079271621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739988100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2018 | ||||||||
| LastUpdateDate: | 01/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | J1-0003819 | DE | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | 40QA177200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.