Provider Demographics
NPI:1245205954
Name:DE JESUS, MARIA RICHELLE SORIANO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA RICHELLE
Middle Name:SORIANO
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARIA RICHELLE
Other - Middle Name:CAMPOS
Other - Last Name:SORIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7 SHEPHERD WAY
Mailing Address - Street 2:KENDALL PARK
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1463
Mailing Address - Country:US
Mailing Address - Phone:732-404-1455
Mailing Address - Fax:732-404-1455
Practice Address - Street 1:822 N WOOD AVE
Practice Address - Street 2:LINDEN
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4038
Practice Address - Country:US
Practice Address - Phone:908-936-8700
Practice Address - Fax:908-936-8701
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00691200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023819MWSMedicare ID - Type Unspecified