MEDICARE: MARIA HENRIETTA DEMAISIP 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	025160	NY
2	225100000X	Physical Therapist	40QA01210300	NJ

General Provider Information

NPI Number	:	1417000886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA HENRIETTA DEMAISIP PT

Provider Business Mailing Address
First Line	:	20736 SHEARWATER CT W
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-5469
Country	:	US
Telephone Number	:	917-415-7992
Fax Number	:

Provider Business Practice Location Address
First Line	:	20736 SHEARWATER CT W
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-5469
Country	:	US
Telephone Number	:	917-415-7992
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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