Provider Demographics
NPI:1669774220
Name:BAYRAM, PEMBE
Entity type:Individual
Prefix:MS
First Name:PEMBE
Middle Name:
Last Name:BAYRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEMBE
Other - Middle Name:
Other - Last Name:BAYRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:270 PINDLE AVE
Mailing Address - Street 2:APT B-2
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6702
Mailing Address - Country:US
Mailing Address - Phone:201-362-5669
Mailing Address - Fax:201-408-4517
Practice Address - Street 1:470 CHAMBERLAIN AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1031
Practice Address - Country:US
Practice Address - Phone:973-782-4540
Practice Address - Fax:973-782-4543
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01374300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist