Provider Demographics
NPI:1629663786
Name:PURCHLA, MAGDALENA ALEKSANDRA
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:ALEKSANDRA
Last Name:PURCHLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1646
Mailing Address - Country:US
Mailing Address - Phone:908-463-1174
Mailing Address - Fax:
Practice Address - Street 1:505 MORRIS AVE STE 103
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1032
Practice Address - Country:US
Practice Address - Phone:973-379-7006
Practice Address - Fax:973-379-7007
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025449225X00000X
NJ46TR00977500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist