Provider Demographics
NPI:1912440660
Name:BILECKY, MERYL GAIL (PTA)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:GAIL
Last Name:BILECKY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 DOVER GRN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1710
Mailing Address - Country:US
Mailing Address - Phone:718-938-3172
Mailing Address - Fax:
Practice Address - Street 1:1120 PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2770
Practice Address - Country:US
Practice Address - Phone:201-703-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00334200225200000X
NY66010246225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant