Provider Demographics
NPI:1538327895
Name:SURRIGA, MARYEL PAGUNTALAN (PT)
Entity Type:Individual
Prefix:MISS
First Name:MARYEL
Middle Name:PAGUNTALAN
Last Name:SURRIGA
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 1:261 LONG MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2256
Mailing Address - Country:US
Mailing Address - Phone:908-346-0199
Mailing Address - Fax:
Practice Address - Street 1:261 LONG MEADOW RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2256
Practice Address - Country:US
Practice Address - Phone:908-346-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33586225100000X
NJ40QA01152000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist