Provider Demographics
NPI:1528734217
Name:GUMIRAN, BERNADETTE ABINGUNA (PT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ABINGUNA
Last Name:GUMIRAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3031
Mailing Address - Country:US
Mailing Address - Phone:203-722-2474
Mailing Address - Fax:
Practice Address - Street 1:1914A LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3284
Practice Address - Country:US
Practice Address - Phone:848-256-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010667225100000X
NY039365-1225100000X
NJ40QA02019600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist