Provider Demographics
NPI:1275781734
Name:KABBANI, NOUR (PT)
Entity Type:Individual
Prefix:
First Name:NOUR
Middle Name:
Last Name:KABBANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2602
Mailing Address - Country:US
Mailing Address - Phone:973-345-8200
Mailing Address - Fax:973-345-2906
Practice Address - Street 1:1117 MAIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2379
Practice Address - Country:US
Practice Address - Phone:973-405-6090
Practice Address - Fax:973-405-6088
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01285300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist