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NPI Code Detail

MEDICARE: JANE PERENA-FUENTES PT

MEDICARE: JANE PERENA-FUENTES 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
1225100000XPhysical Therapist40QA00944700NJ

General Provider Information

NPI Number : 1982764619
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE PERENA-FUENTES PT
Provider Business Mailing Address
First Line : 749 N BROAD ST APT 305
Second Line :
City : ELIZABETH
State : NJ
Zip : 07208-2411
Country : US
Telephone Number : 908-764-9603
Fax Number :
Provider Business Practice Location Address
First Line : 50 GREENBROOK RD
Second Line :
City : NORTH PLAINFIELD
State : NJ
Zip : 07060-4560
Country : US
Telephone Number : 908-755-2111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 07/08/2007

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Directions to “ JANE PERENA-FUENTES PT” Practice Location

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