Provider Demographics
NPI:1104060268
Name:GARDUQUE, CESAR VALENTE JR (OTR)
Entity type:Individual
Prefix:MR
First Name:CESAR
Middle Name:VALENTE
Last Name:GARDUQUE
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 POLIFLY RD APT 311
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3295
Mailing Address - Country:US
Mailing Address - Phone:646-206-1025
Mailing Address - Fax:201-880-0614
Practice Address - Street 1:54 POLIFLY RD APT 311
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3295
Practice Address - Country:US
Practice Address - Phone:646-206-1025
Practice Address - Fax:201-880-0614
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00447800OtherNJ STATE LICENSE
NY013016OtherNYSED