Provider Demographics
NPI:1508078783
Name:CAYABYAB, MIRVI MALADO
Entity Type:Individual
Prefix:
First Name:MIRVI
Middle Name:MALADO
Last Name:CAYABYAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 SCHMIDT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1358
Mailing Address - Country:US
Mailing Address - Phone:732-297-2586
Mailing Address - Fax:
Practice Address - Street 1:1080 SCHMIDT LN
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1358
Practice Address - Country:US
Practice Address - Phone:732-297-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01239600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist