Provider Demographics
NPI:1326286188
Name:ENRIQUEZ, ELEANOR (PT)
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:ENRIQUEZ
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 1:37 FRANCIS PL
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4818
Mailing Address - Country:US
Mailing Address - Phone:347-481-1631
Mailing Address - Fax:
Practice Address - Street 1:1600 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2764
Practice Address - Country:US
Practice Address - Phone:732-428-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-31
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01301900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist