MEDICARE: ANGELICA HADDAD DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA02401700	NJ

General Provider Information

NPI Number	:	1235085093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA HADDAD DPT

Provider Business Mailing Address
First Line	:	15 PINE ST
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-4455
Country	:	US
Telephone Number	:	732-619-4990
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 GEORGE ST STE 104
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2009
Country	:	US
Telephone Number	:	732-724-2355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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