Provider Demographics
NPI:1609805746
Name:TUASON, CAYETANO MARK (PT)
Entity Type:Individual
Prefix:MR
First Name:CAYETANO
Middle Name:MARK
Last Name:TUASON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 GATES CT
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3440
Mailing Address - Country:US
Mailing Address - Phone:862-215-4595
Mailing Address - Fax:
Practice Address - Street 1:554 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1338
Practice Address - Country:US
Practice Address - Phone:973-483-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01108600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5890450001OtherNJ MEDICARE DMERC
NJ065646Q97Medicare PIN
NJ5890450001OtherNJ MEDICARE DMERC
NJ026090Medicare ID - Type UnspecifiedGROUP ID
NJ097138M7KMedicare PIN