Provider Demographics
NPI:1427293489
Name:NASCIMENTO, ELISEU A (PT)
Entity type:Individual
Prefix:MRS
First Name:ELISEU
Middle Name:A
Last Name:NASCIMENTO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MCWHORTER STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:973-494-0858
Mailing Address - Fax:844-857-2827
Practice Address - Street 1:225 MCWHORTER STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-494-0858
Practice Address - Fax:844-857-2827
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030269225100000X
NJ40QA01293800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist