Provider Demographics
NPI:1881069631
Name:SORIANO, BETTY (LMT MMP)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:SORIANO
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N WASHINGTON AVE UNIT L4
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1771
Mailing Address - Country:US
Mailing Address - Phone:201-314-2532
Mailing Address - Fax:
Practice Address - Street 1:80 N WASHINGTON AVE UNIT L4
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1771
Practice Address - Country:US
Practice Address - Phone:201-314-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00632600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist