Provider Demographics
NPI:1336889765
Name:NUNEZ, ELBA MELINA
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:MELINA
Last Name:NUNEZ
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 1:52 CLAVERACK RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1577
Mailing Address - Country:US
Mailing Address - Phone:862-374-6440
Mailing Address - Fax:
Practice Address - Street 1:214 W HOUSTON ST # 214
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4846
Practice Address - Country:US
Practice Address - Phone:212-337-9400
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ729197973Medicaid