Provider Demographics
NPI:1083733208
Name:TAWADROS, STEPHEN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TAWADROS
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 1:8 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9658
Mailing Address - Country:US
Mailing Address - Phone:201-647-3669
Mailing Address - Fax:
Practice Address - Street 1:623 LAFAYETTE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2439
Practice Address - Country:US
Practice Address - Phone:201-647-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01117600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist