Provider Demographics
NPI:1003142746
Name:ONGSUCO, MARY TSAREVICH
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TSAREVICH
Last Name:ONGSUCO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:TSAREVICH
Other - Last Name:LIBO-ON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 WELDON RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3724
Mailing Address - Country:US
Mailing Address - Phone:646-267-0502
Mailing Address - Fax:
Practice Address - Street 1:4 WELDON RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3724
Practice Address - Country:US
Practice Address - Phone:646-267-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01077600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist