Provider Demographics
NPI:1235425430
Name:BERNABE, RESHELLE
Entity Type:Individual
Prefix:
First Name:RESHELLE
Middle Name:
Last Name:BERNABE
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 1:1 GRANDVIEW TER
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1636
Mailing Address - Country:US
Mailing Address - Phone:862-215-4330
Mailing Address - Fax:201-825-2920
Practice Address - Street 1:1 GRANDVIEW TER
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1636
Practice Address - Country:US
Practice Address - Phone:862-215-4330
Practice Address - Fax:201-825-2920
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00958100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist