Provider Demographics
NPI:1376710012
Name:DIAZ, EILEEN REILLY (PT, RN)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:REILLY
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1916
Mailing Address - Country:US
Mailing Address - Phone:973-744-1680
Mailing Address - Fax:973-655-0971
Practice Address - Street 1:51 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1916
Practice Address - Country:US
Practice Address - Phone:973-744-1680
Practice Address - Fax:973-655-0971
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00498800225100000X, 2251H1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors