Provider Demographics
NPI:1740469766
Name:BANK, CARMENCITA ANDREA (PT)
Entity type:Individual
Prefix:MRS
First Name:CARMENCITA
Middle Name:ANDREA
Last Name:BANK
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 1:13 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2209
Mailing Address - Country:US
Mailing Address - Phone:201-436-6966
Mailing Address - Fax:
Practice Address - Street 1:13 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2209
Practice Address - Country:US
Practice Address - Phone:201-436-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00685800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist