Provider Demographics
NPI:1417375585
Name:MAGANA, ELMER
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:
Last Name:MAGANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 MCGILLVRAY PL
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-1349
Mailing Address - Country:US
Mailing Address - Phone:908-764-1227
Mailing Address - Fax:
Practice Address - Street 1:807 MCGILLVRAY PL
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-1349
Practice Address - Country:US
Practice Address - Phone:908-764-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00194000225200000X
NY004837-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant