Provider Demographics
NPI:1376660928
Name:PAYESKO, THERESA M (RN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:PAYESKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1531
Mailing Address - Country:US
Mailing Address - Phone:908-896-4740
Mailing Address - Fax:
Practice Address - Street 1:1801 E 2ND ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1749
Practice Address - Country:US
Practice Address - Phone:908-322-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08847700163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health