MEDICARE: MR. WAYNE G. SEMBRANO LPT

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	174400000X	Specialist	40QA01132800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40QA01132800	OTHER	NJ	PHYSICAL THERAPIST LICENS

General Provider Information

NPI Number	:	1558467860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE G. SEMBRANO LPT

Provider Business Mailing Address
First Line	:	11 EAGLE ROCK AVE
Second Line	:	FL 2
City	:	EAST HANOVER
State	:	NJ
Zip	:	07936-3167
Country	:	US
Telephone Number	:	908-474-9444
Fax Number	:	908-474-8561

Provider Business Practice Location Address
First Line	:	10 N WOOD AVE
Second Line	:	SUITE E
City	:	LINDEN
State	:	NJ
Zip	:	07036-5200
Country	:	US
Telephone Number	:	908-474-9444
Fax Number	:	908-474-8561

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	01/18/2018

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