Provider Demographics
NPI:1689926925
Name:PABLO, RENAN CUYSON (RPT)
Entity Type:Individual
Prefix:MR
First Name:RENAN
Middle Name:CUYSON
Last Name:PABLO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BANKS RD APT 8A
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-8157
Mailing Address - Country:US
Mailing Address - Phone:205-522-2488
Mailing Address - Fax:
Practice Address - Street 1:100 METROPLEX DR STE 102
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2684
Practice Address - Country:US
Practice Address - Phone:732-572-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01465700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist