Healthcare Provider Details

I. General information

NPI: 1538139084
Provider Name (Legal Business Name): CARLOS R RANGEL MSPT, CWCE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 2ND AVE
CEDAR GROVE NJ
07009-1141
US

IV. Provider business mailing address

194 2ND AVE
CEDAR GROVE NJ
07009-1141
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-0330
  • Fax: 973-812-0339
Mailing address:
  • Phone: 973-256-0330
  • Fax: 973-812-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00932200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: