Provider Demographics
NPI:1366758120
Name:BERMUDO, VOLTAIRE VINCENT (PT)
Entity type:Individual
Prefix:MR
First Name:VOLTAIRE
Middle Name:VINCENT
Last Name:BERMUDO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 SYLVAN AVE
Mailing Address - Street 2:STE 1270
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3119
Mailing Address - Country:US
Mailing Address - Phone:201-731-3724
Mailing Address - Fax:201-731-3726
Practice Address - Street 1:560 SYLVAN AVE
Practice Address - Street 2:SUITE 1270
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3119
Practice Address - Country:US
Practice Address - Phone:201-731-3724
Practice Address - Fax:201-731-3726
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029822-1225100000X
NJ40QA01383000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102614Medicare UPIN