=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063846996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. EVA CSIKI HORESCO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2013
-----------------------------------------------------
Last Update Date | 08/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 MARSHALL RD
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-359-0086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 MARSHALL RD
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-359-0086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 46TR00196100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------