Provider Demographics
NPI:1518201334
Name:ABOUELLEIL, TAHER (DPT)
Entity Type:Individual
Prefix:
First Name:TAHER
Middle Name:
Last Name:ABOUELLEIL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SILVERTON PL
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-1477
Mailing Address - Country:US
Mailing Address - Phone:347-664-5131
Mailing Address - Fax:
Practice Address - Street 1:3325 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1552
Practice Address - Country:US
Practice Address - Phone:732-264-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014392002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics