Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 40QB00144200 | NJ |
NPI | 1013121466 |
---|---|
Provider Name | Ms. Eileen Enrico |
First Address | Hoboken, NJ 07030-2753 |
Second Address | Belleville, NJ 07109-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |