MEDICARE: MRS. JENNIFER CAPIRAL NERONA 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	40QA01341600	NJ

General Provider Information

NPI Number	:	1578893095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER CAPIRAL NERONA PT

Provider Business Mailing Address
First Line	:	476 BAILEY AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-8824
Country	:	US
Telephone Number	:	646-578-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 E SAINT GEORGES AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-1782
Country	:	US
Telephone Number	:	908-486-8899
Fax Number	:	908-486-8951

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

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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