MEDICARE: ALFIE SHEILA MARQUEZ 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	40QA01212100	NJ

General Provider Information

NPI Number	:	1255538443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFIE SHEILA MARQUEZ PT

Provider Business Mailing Address
First Line	:	590 NEWARK AVE
Second Line	:	SUITE 2
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2302
Country	:	US
Telephone Number	:	201-420-1165
Fax Number	:	201-420-6893

Provider Business Practice Location Address
First Line	:	590 NEWARK AVE
Second Line	:	SUITE 2A
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2302
Country	:	US
Telephone Number	:	201-420-1165
Fax Number	:	201-420-6893

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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Directions to “ ALFIE SHEILA MARQUEZ PT” Practice Location

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