Provider Demographics
NPI:1407827330
Name:INGEMI, BASIL J (MS PT CERTMDT)
Entity Type:Individual
Prefix:MR
First Name:BASIL
Middle Name:J
Last Name:INGEMI
Suffix:
Gender:M
Credentials:MS PT CERTMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MANHEIM AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2136
Mailing Address - Country:US
Mailing Address - Phone:856-455-9700
Mailing Address - Fax:856-455-9791
Practice Address - Street 1:70 MANHEIM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2136
Practice Address - Country:US
Practice Address - Phone:856-455-9700
Practice Address - Fax:856-455-9791
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00563600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ193525Medicare PIN
NJ316704Medicare PIN