Provider Demographics
NPI:1376929463
Name:ROGALES-ILAGAN, NOEMI B (PT)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:B
Last Name:ROGALES-ILAGAN
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 1:1219 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5233
Mailing Address - Country:US
Mailing Address - Phone:908-687-4452
Mailing Address - Fax:
Practice Address - Street 1:1219 SHETLAND DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5233
Practice Address - Country:US
Practice Address - Phone:908-687-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00686200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist