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General NPI Number Information
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NPI Number | 1366468076
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Entity Type | Individual
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Provider Name | DIAGELIA NERVEZ PT
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 390 BENNETTS LN
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City | SOMERSET
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State | NJ
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Zip | 08873-7707
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Country | US
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Telephone | 732-545-2222
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Fax | 732-568-0663
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Provider Business Mailing Address
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Address Line | PO BOX 5703
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City | SOMERSET
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State | NJ
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Zip | 08875-5703
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Country | US
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Telephone | 848-565-7472
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Fax | 732-568-0663
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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 | 40QA00731700
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License Number State | NJ
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