MEDICARE: MR. HUMBERTO COLMENARES P.T.

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	2251X0800X	Orthopedic Physical Therapist	40QA00489600	NJ

General Provider Information

NPI Number	:	1245395235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUMBERTO COLMENARES P.T.

Provider Business Mailing Address
First Line	:	701 NEWARK AVE STE 212
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-3560
Country	:	US
Telephone Number	:	908-527-6001
Fax Number	:	908-527-6634

Provider Business Practice Location Address
First Line	:	75 MONTGOMERY ST FL 501
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3726
Country	:	US
Telephone Number	:	201-433-6001
Fax Number	:	201-433-6634

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	02/27/2020

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