Provider Demographics
NPI:1710197819
Name:PEPINGCO, MARICON SIAPNO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARICON
Middle Name:SIAPNO
Last Name:PEPINGCO
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 1:913 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHA
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-4543
Mailing Address - Country:US
Mailing Address - Phone:908-387-9321
Mailing Address - Fax:
Practice Address - Street 1:913 7TH AVE
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:NJ
Practice Address - Zip Code:08865-4543
Practice Address - Country:US
Practice Address - Phone:908-387-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01226200225100000X
PAPT019272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT019272OtherSTATE BOARD OF PHYSICAL THERAPY
NJPT40QA01226200OtherSTATE BOARD OF PHYSICAL THERAPY