Healthcare Provider Details

I. General information

NPI: 1982764619
Provider Name (Legal Business Name): JANE PERENA-FUENTES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GREENBROOK RD
NORTH PLAINFIELD NJ
07060-4560
US

IV. Provider business mailing address

749 N BROAD ST APT 305
ELIZABETH NJ
07208-2411
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-2111
  • Fax:
Mailing address:
  • Phone: 908-764-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00944700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: