Provider Demographics
NPI:1316626518
Name:FERNANDEZ, ORIETTA MAGALY (MANUAL THERAPIST)
Entity type:Individual
Prefix:
First Name:ORIETTA
Middle Name:MAGALY
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MANUAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PIAGET AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1216
Mailing Address - Country:US
Mailing Address - Phone:201-640-8989
Mailing Address - Fax:
Practice Address - Street 1:1135 BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3346
Practice Address - Country:US
Practice Address - Phone:917-833-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01421500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist