Provider Demographics
NPI:1306242029
Name:DUQUETTE, MARIA EMMA MISMANOS (PTA)
Entity type:Individual
Prefix:
First Name:MARIA EMMA
Middle Name:MISMANOS
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1326
Mailing Address - Country:US
Mailing Address - Phone:240-409-7155
Mailing Address - Fax:
Practice Address - Street 1:81 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1326
Practice Address - Country:US
Practice Address - Phone:240-409-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009276225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant