Provider Demographics
NPI:1093833394
Name:SOLOMON, HERALDINE DUEVO (RPT)
Entity Type:Individual
Prefix:MISS
First Name:HERALDINE
Middle Name:DUEVO
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:HERALDINE
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:935 BROAD ST # 3C
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2841
Mailing Address - Country:US
Mailing Address - Phone:617-953-2129
Mailing Address - Fax:
Practice Address - Street 1:25 E LINDSLEY RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1023
Practice Address - Country:US
Practice Address - Phone:973-256-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17153225100000X
NJPT40QA01215100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist