Healthcare Provider Details

I. General information

NPI: 1003835158
Provider Name (Legal Business Name): PAUL LAYUGAN BALISI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FRANKLIN TPKE STE 9
MAHWAH NJ
07430-1364
US

IV. Provider business mailing address

180 FRANKLIN TPKE STE 9
MAHWAH NJ
07430-1364
US

V. Phone/Fax

Practice location:
  • Phone: 201-828-9290
  • Fax: 201-828-9670
Mailing address:
  • Phone: 201-828-9290
  • Fax: 201-828-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA00769300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: