Provider Demographics
NPI:1003835158
Name:BALISI, PAUL LAYUGAN (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LAYUGAN
Last Name:BALISI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FRANKLIN TPKE STE 9
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1364
Mailing Address - Country:US
Mailing Address - Phone:201-828-9290
Mailing Address - Fax:201-828-9670
Practice Address - Street 1:180 FRANKLIN TPKE STE 9
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1364
Practice Address - Country:US
Practice Address - Phone:201-828-9290
Practice Address - Fax:201-828-9670
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00769300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050161Medicare ID - Type UnspecifiedPT