Provider Demographics
NPI:1346593290
Name:ANACIN, MA.REICHEL SARAIDA
Entity Type:Individual
Prefix:MRS
First Name:MA.REICHEL
Middle Name:SARAIDA
Last Name:ANACIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MA.REICHEL
Other - Middle Name:MATTA
Other - Last Name:SARAIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2951
Practice Address - Country:US
Practice Address - Phone:732-849-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist