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General NPI Number Information
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NPI Number | 1346590379
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Entity Type | Individual
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Provider Name | STACY L PASERCHIA PT, MPT, TDPT
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Gender | Female
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 151 SUMMIT AVE STE 1
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City | SUMMIT
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State | NJ
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Zip | 07901-2813
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Country | US
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Telephone | 732-322-6858
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Fax |
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Provider Business Mailing Address
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Address Line | 25 CATON TER
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City | CALDWELL
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State | NJ
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Zip | 07006-4808
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Country | US
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Telephone | 732-322-6858
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Fax |
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 40QA01287700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01287700
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License Number State | NJ
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