Healthcare Provider Details

I. General information

NPI: 1477712446
Provider Name (Legal Business Name): MA LOURDES MARICHU BEBITA ZITA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 WASHINGTON AVENUE
DUMONT NJ
07628
US

IV. Provider business mailing address

315 MONMOUTH
NEW MILFORD NJ
07646
US

V. Phone/Fax

Practice location:
  • Phone: 201-244-8908
  • Fax:
Mailing address:
  • Phone: 201-244-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01271100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: