Provider Demographics
NPI:1073118097
Name:GARCIA, BERNARDO PAUL AVENIDO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BERNARDO PAUL
Middle Name:AVENIDO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1125
Mailing Address - Country:US
Mailing Address - Phone:201-855-6294
Mailing Address - Fax:
Practice Address - Street 1:185 NJ-17 S
Practice Address - Street 2:SUITE 101B
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-560-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01978700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist