Provider Demographics
NPI:1669425294
Name:OMBAJIN, CZARINA TIPON (RPT)
Entity type:Individual
Prefix:MRS
First Name:CZARINA
Middle Name:TIPON
Last Name:OMBAJIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:CZARINA
Other - Middle Name:TIPON
Other - Last Name:DE LOS SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:511 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-796-5273
Mailing Address - Fax:201-796-8645
Practice Address - Street 1:511 BOULEVARD
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:201-796-5273
Practice Address - Fax:201-796-8645
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01095700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
085183Medicare ID - Type Unspecified