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NPI Code Detail

MEDICARE: THOMAS BIANCO JR. PT

MEDICARE:   THOMAS  BIANCO JR. PT
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
1174400000XSpecialist40QA00781300NJ
2225100000XPhysical Therapist40QA00781300NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00282017OTHERNJRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12713128OTHERNJCIGNA PPO
21962696OTHERNJUNITEDHEALTHCARE MPIN

General Provider Information

NPI Number : 1639266190
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS BIANCO JR. PT
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE STE 140
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5224
Country : US
Telephone Number : 888-830-4125
Fax Number :
Provider Business Practice Location Address
First Line : 1940 S WEST BLVD BLDG A
Second Line :
City : VINELAND
State : NJ
Zip : 08360-7024
Country : US
Telephone Number : 856-690-9977
Fax Number : 856-507-9918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 09/24/2021

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Directions to “ THOMAS BIANCO JR. PT” Practice Location

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