Healthcare Provider Details

I. General information

NPI: 1316867385
Provider Name (Legal Business Name): EMMANUEL BERMEO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HERON DR
HACKETTSTOWN NJ
07840-4530
US

IV. Provider business mailing address

4 HERON DR
HACKETTSTOWN NJ
07840-4530
US

V. Phone/Fax

Practice location:
  • Phone: 732-261-9928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00927100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: