Healthcare Provider Details

I. General information

NPI: 1184741332
Provider Name (Legal Business Name): MARIA GUISELA CUNANAN ESGUERRA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SUMMIT ST
WEST ORANGE NJ
07052-1501
US

IV. Provider business mailing address

265 LAKE SHORE DR
LAKE HIAWATHA NJ
07034-1603
US

V. Phone/Fax

Practice location:
  • Phone: 973-736-2000
  • Fax:
Mailing address:
  • Phone: 973-299-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01011700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: