Provider Demographics
NPI:1033250303
Name:DEANG, EDUARDO B (PT)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:B
Last Name:DEANG
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 1:12-63 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1833
Mailing Address - Country:US
Mailing Address - Phone:201-281-4157
Mailing Address - Fax:
Practice Address - Street 1:161B N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1739
Practice Address - Country:US
Practice Address - Phone:201-387-2800
Practice Address - Fax:201-387-2248
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01169900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist