Provider Demographics
NPI:1750608501
Name:FAVALE, VANESSA L (NCMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:FAVALE
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 MARKET ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5300
Mailing Address - Country:US
Mailing Address - Phone:201-712-0009
Mailing Address - Fax:201-712-0040
Practice Address - Street 1:383 MARKET ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5300
Practice Address - Country:US
Practice Address - Phone:201-712-0009
Practice Address - Fax:201-712-0040
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist