Provider Demographics
NPI:1669087565
Name:FODOR, GYONGYI
Entity type:Individual
Prefix:
First Name:GYONGYI
Middle Name:
Last Name:FODOR
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 1:78. ANDERSON HILL RD.
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924
Mailing Address - Country:US
Mailing Address - Phone:201-669-8391
Mailing Address - Fax:
Practice Address - Street 1:78. ANDERSON HILL RD.
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924
Practice Address - Country:US
Practice Address - Phone:201-669-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00132000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist