Provider Demographics
NPI:1659434538
Name:BABU, SURESH (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:BABU
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3562 STATE ROUTE 27 STE 124
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1062
Mailing Address - Country:US
Mailing Address - Phone:732-853-8177
Mailing Address - Fax:732-853-8169
Practice Address - Street 1:3562 STATE ROUTE 27 STE 124
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1062
Practice Address - Country:US
Practice Address - Phone:732-853-8177
Practice Address - Fax:732-853-8169
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011158002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ180947DBDOtherMEDICARE