Provider Demographics
NPI:1639266190
Name:BIANCO, THOMAS JR (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BIANCO
Suffix:JR
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 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:888-830-4125
Mailing Address - Fax:
Practice Address - Street 1:1940 S WEST BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7024
Practice Address - Country:US
Practice Address - Phone:856-690-9977
Practice Address - Fax:856-507-9918
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00781300174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2713128OtherCIGNA PPO
NJ1962696OtherUNITEDHEALTHCARE MPIN
NJP00282017OtherRAILROAD MEDICARE
NJP00282017OtherRAILROAD MEDICARE