Provider Demographics
NPI:1245563998
Name:MAROO, VINI (PT)
Entity Type:Individual
Prefix:MRS
First Name:VINI
Middle Name:
Last Name:MAROO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VINI
Other - Middle Name:
Other - Last Name:DAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:907 GREEN HILL MANOR DRIVE
Mailing Address - Street 2:APRT 907
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:201-379-3709
Mailing Address - Fax:
Practice Address - Street 1:380 DEMOTT AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-493-3100
Practice Address - Fax:732-493-4285
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01329300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist