Provider Demographics
NPI:1275830549
Name:PENHA, MARCIA
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:PENHA
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 1:168 W PASSAIC ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1256
Mailing Address - Country:US
Mailing Address - Phone:201-956-8334
Mailing Address - Fax:
Practice Address - Street 1:205 ROBIN RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1449
Practice Address - Country:US
Practice Address - Phone:201-225-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00247600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist