Provider Demographics
NPI:1689915977
Name:PUNZALAN, NOEL PARAS (PT)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:PARAS
Last Name:PUNZALAN
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 1:55 SHORT HILLS CIR APT 2A
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1230
Mailing Address - Country:US
Mailing Address - Phone:718-801-9726
Mailing Address - Fax:
Practice Address - Street 1:55 SHORT HILLS CIR APT 2A
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1230
Practice Address - Country:US
Practice Address - Phone:718-801-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01281900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist