Basic Information
| Provider Information | |||||||||
| NPI: | 1649346479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTACIO | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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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: | 11/24/2006 | ||||||||
| LastUpdateDate: | 12/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/24/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 40QA01036700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.