Provider Demographics
NPI:1144943572
Name:SINGH, MARISSA NAUDIA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:NAUDIA
Last Name:SINGH
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 1:300 VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-1531
Mailing Address - Country:US
Mailing Address - Phone:732-491-3479
Mailing Address - Fax:
Practice Address - Street 1:1111 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2814
Practice Address - Country:US
Practice Address - Phone:908-360-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00400300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant