Provider Demographics
NPI:1417548371
Name:ESPINOLA, EPHER SERRANO (PT)
Entity Type:Individual
Prefix:MR
First Name:EPHER
Middle Name:SERRANO
Last Name:ESPINOLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LIVINGSTON ST STE 112
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1739
Mailing Address - Country:US
Mailing Address - Phone:201-564-7515
Mailing Address - Fax:201-564-7514
Practice Address - Street 1:220 LIVINGSTON ST STE 112
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1739
Practice Address - Country:US
Practice Address - Phone:201-564-7515
Practice Address - Fax:201-564-7514
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01955900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist