Basic Information
| Provider Information | |||||||||
| NPI: | 1043890338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAIZMAN | ||||||||
| FirstName: | YEVGENIA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MAIN ST STE 505 | ||||||||
| Address2: | |||||||||
| City: | EATONTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324933100 | ||||||||
| FaxNumber: | 7328764967 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MAIN ST STE 505 | ||||||||
| Address2: | |||||||||
| City: | EATONTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324933100 | ||||||||
| FaxNumber: | 7328764967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2021 | ||||||||
| LastUpdateDate: | 04/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 40QB00358100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.