Provider Demographics
NPI:1093738452
Name:BANHON, ALEXANDRE (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:BANHON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EMERY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1368
Mailing Address - Country:US
Mailing Address - Phone:973-895-9925
Mailing Address - Fax:973-895-9927
Practice Address - Street 1:2 EMERY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1368
Practice Address - Country:US
Practice Address - Phone:973-895-9925
Practice Address - Fax:973-895-9927
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00165700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant