MEDICARE: MR. EDUARDO B DEANG PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01169900	NJ

General Provider Information

NPI Number	:	1033250303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDUARDO B DEANG PT

Provider Business Mailing Address
First Line	:	12-63 GEORGE ST
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-1833
Country	:	US
Telephone Number	:	201-281-4157
Fax Number	:

Provider Business Practice Location Address
First Line	:	161B N WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1739
Country	:	US
Telephone Number	:	201-387-2800
Fax Number	:	201-387-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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