MEDICARE: ANDREI-ANGELO BERBERABE GENIO OTR/L

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	225X00000X	Occupational Therapist	46TR01101100	NJ

General Provider Information

NPI Number	:	1821700790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREI-ANGELO BERBERABE GENIO OTR/L

Provider Business Mailing Address
First Line	:	116 CENTRAL AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2120
Country	:	US
Telephone Number	:	201-982-3266
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S PARK AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-1101
Country	:	US
Telephone Number	:	908-487-6892
Fax Number	:

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

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	12/21/2022

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