Healthcare Provider Details

I. General information

NPI: 1043241953
Provider Name (Legal Business Name): EMMANUEL MARCOS RAMOS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 STATE RT 153
SECAUCUS NJ
07094-3445
US

IV. Provider business mailing address

380 FRONT ST APT 4
SECAUCUS NJ
07094-3364
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-0010
  • Fax: 201-319-8994
Mailing address:
  • Phone: 201-709-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00837100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: