Provider Demographics
NPI:1124229364
Name:WILEY, ANGELETTE M (MPT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELETTE
Middle Name:M
Last Name:WILEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 FOREST HAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-6317
Mailing Address - Country:US
Mailing Address - Phone:917-569-7495
Mailing Address - Fax:
Practice Address - Street 1:615 23RD ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3505
Practice Address - Country:US
Practice Address - Phone:201-348-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01208800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist