Provider Demographics
NPI:1770930752
Name:PAIS, INGRID
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:PAIS
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 1:388 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1814
Mailing Address - Country:US
Mailing Address - Phone:973-228-0500
Mailing Address - Fax:973-228-0501
Practice Address - Street 1:388 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1814
Practice Address - Country:US
Practice Address - Phone:973-228-0500
Practice Address - Fax:973-228-0501
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00396200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00396200OtherPHYSICAL THERAPY STATE LICENSE