Provider Demographics
NPI:1710455969
Name:URBINA, MICHELLE ANGELA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELA
Last Name:URBINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 EDWIN AVE APT 4E
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4822
Mailing Address - Country:US
Mailing Address - Phone:201-956-3020
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17 STE 101
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2818
Practice Address - Country:US
Practice Address - Phone:201-261-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist