MEDICARE: GERALDINE IFUNANYA AMADI

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	40QA02086200	NJ

General Provider Information

NPI Number	:	1790411726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE IFUNANYA AMADI

Provider Business Mailing Address
First Line	:	70 WILDCAT BRANCH DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-4890
Country	:	US
Telephone Number	:	856-739-6394
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 BARROW ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3578
Country	:	US
Telephone Number	:	201-433-2096
Fax Number	:

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	08/05/2022

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