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NPI Code Detail

MEDICARE: RENATA TUBIAK PTA

MEDICARE: RENATA TUBIAK PTA
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
1225200000XPhysical Therapy Assistant40QB00257500NJ

General Provider Information

NPI Number : 1679817126
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENATA TUBIAK PTA
Provider Business Mailing Address
First Line : 20B TRIUMPH CT
Second Line :
City : EAST RUTHERFORD
State : NJ
Zip : 07073-1147
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3161 KENNEDY BLVD
Second Line :
City : NORTH BERGEN
State : NJ
Zip : 07047-2303
Country : US
Telephone Number : 201-867-3585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2012
Last Update Date : 11/23/2012

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Directions to “ RENATA TUBIAK PTA” Practice Location

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