Provider Demographics
NPI:1962115576
Name:MINAYA, ELISCIA (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:ELISCIA
Middle Name:
Last Name:MINAYA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1365
Mailing Address - Country:US
Mailing Address - Phone:201-220-9454
Mailing Address - Fax:
Practice Address - Street 1:17 LEGION PL
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3209
Practice Address - Country:US
Practice Address - Phone:201-843-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00238400225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty