Provider Demographics
NPI:1952465601
Name:RAYMUNDO, MARIEFYL MANGULABNAN (PT)
Entity Type:Individual
Prefix:
First Name:MARIEFYL
Middle Name:MANGULABNAN
Last Name:RAYMUNDO
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 1:4501 HIGHWAY 39 N
Mailing Address - Street 2:APT 3C
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1073
Mailing Address - Country:US
Mailing Address - Phone:862-596-2890
Mailing Address - Fax:
Practice Address - Street 1:171 RIDGEDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1764
Practice Address - Country:US
Practice Address - Phone:973-377-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01152700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091446Medicare ID - Type Unspecified