Provider Demographics
NPI:1538139084
Name:RANGEL, CARLOS R (MSPT, CWCE)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:RANGEL
Suffix:
Gender:M
Credentials:MSPT, CWCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1141
Mailing Address - Country:US
Mailing Address - Phone:973-256-0330
Mailing Address - Fax:973-812-0339
Practice Address - Street 1:194 2ND AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1141
Practice Address - Country:US
Practice Address - Phone:973-256-0330
Practice Address - Fax:973-812-0339
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA009322002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ044802PL1Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #