Provider Demographics
NPI:1356367627
Name:NAVAL, MARIA CIELO S (PT)
Entity type:Individual
Prefix:
First Name:MARIA CIELO
Middle Name:S
Last Name:NAVAL
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 1:750 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1353
Mailing Address - Country:US
Mailing Address - Phone:973-345-1312
Mailing Address - Fax:973-742-0669
Practice Address - Street 1:750 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1353
Practice Address - Country:US
Practice Address - Phone:973-345-1312
Practice Address - Fax:973-742-0669
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00474500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026083OtherAETNA
NJ0026083OtherAETNA