Provider Demographics
NPI:1891920609
Name:NIEVA, CARMENCHU CONSTANTINO (PT)
Entity Type:Individual
Prefix:
First Name:CARMENCHU
Middle Name:CONSTANTINO
Last Name:NIEVA
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 1:166 E MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2536
Mailing Address - Country:US
Mailing Address - Phone:201-384-6621
Mailing Address - Fax:201-244-5685
Practice Address - Street 1:166 E MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2536
Practice Address - Country:US
Practice Address - Phone:201-384-6621
Practice Address - Fax:201-244-5685
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0209262251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics