Healthcare Provider Details

I. General information

NPI: 1194914432
Provider Name (Legal Business Name): EILEEN CHRISTINE DECARO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 US HIGHWAY 206
MONTAGUE NJ
07827-3045
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 973-293-0010
  • Fax: 973-293-0018
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01253300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: