Provider Demographics
NPI:1508100975
Name:HERNANDEZ, MELIZA COMPETENTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELIZA
Middle Name:COMPETENTE
Last Name:HERNANDEZ
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 1:1015 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2825
Mailing Address - Country:US
Mailing Address - Phone:732-346-9709
Mailing Address - Fax:
Practice Address - Street 1:1015 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2825
Practice Address - Country:US
Practice Address - Phone:732-346-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01043500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist