Provider Demographics
NPI:1689683237
Name:ENRIQUEZ, CARLA (PT)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:ENRIQUEZ
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 1:171 RIDGEDALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1764
Mailing Address - Country:US
Mailing Address - Phone:973-377-6327
Mailing Address - Fax:973-408-9055
Practice Address - Street 1:171 RIDGEDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1764
Practice Address - Country:US
Practice Address - Phone:973-377-6327
Practice Address - Fax:973-408-9055
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01133300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNON-PAROtherANTHEM
NJ2701321OtherPIN GHI
NJJ31494OtherPIN HEALTHNET
NJ2700276000OtherPIN AMERIHEALTH
NJNON-PAROtherANTHEM