Provider Demographics
NPI:1225214232
Name:ABALOS, AIMEE LYNN ONG
Entity Type:Individual
Prefix:
First Name:AIMEE LYNN
Middle Name:ONG
Last Name:ABALOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 TOMAR CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4014
Mailing Address - Country:US
Mailing Address - Phone:551-998-9676
Mailing Address - Fax:
Practice Address - Street 1:25 TOMAR CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4014
Practice Address - Country:US
Practice Address - Phone:551-998-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01123400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist