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General NPI Number Information
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NPI Number | 1285760710
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Entity Type | Individual
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Provider Name | M. P. NISPEROS P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 517 CENTRAL AVE STE 1
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City | ORANGE
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State | NJ
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Zip | 07050-1433
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Country | US
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Telephone | 973-414-1357
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Fax |
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Provider Business Mailing Address
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Address Line | 53 LINDEN AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1805
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Country | US
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Telephone | 973-704-7734
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Fax | 855-631-4348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT40QA01110500
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License Number State | NJ
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