Provider Demographics
NPI:1851510028
Name:BAMBO, REJANE MARIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:REJANE
Middle Name:MARIA
Last Name:BAMBO
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 1:1055B ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2165
Mailing Address - Country:US
Mailing Address - Phone:732-441-9898
Mailing Address - Fax:732-441-9555
Practice Address - Street 1:1055B ROUTE 34
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2165
Practice Address - Country:US
Practice Address - Phone:732-441-9898
Practice Address - Fax:732-441-9555
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01163000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088317Medicare PIN