Provider Demographics
NPI:1215772108
Name:BIALOW, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BIALOW
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 1:9566 TREVI CT UNIT 4928
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8440
Mailing Address - Country:US
Mailing Address - Phone:201-906-0387
Mailing Address - Fax:
Practice Address - Street 1:68 WATERFORD AVE
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4246
Practice Address - Country:US
Practice Address - Phone:917-470-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00745700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist