Provider Demographics
NPI:1972688802
Name:TIMBANG, JOAN D (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:D
Last Name:TIMBANG
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 1:67 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2015
Mailing Address - Country:US
Mailing Address - Phone:201-310-9785
Mailing Address - Fax:
Practice Address - Street 1:155 W HUDSON AVE # 175
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1609
Practice Address - Country:US
Practice Address - Phone:201-871-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00999700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist