Healthcare Provider Details

I. General information

NPI: 1710904271
Provider Name (Legal Business Name): EWA BIANCO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CEDAR ST
GARWOOD NJ
07027-1107
US

IV. Provider business mailing address

200 CEDAR ST
GARWOOD NJ
07027-1107
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-8512
  • Fax:
Mailing address:
  • Phone: 908-232-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00822300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: