Provider Demographics
NPI:1962601153
Name:IANCU, ELISABETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:IANCU
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 1:42 DAWN CT
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2604
Mailing Address - Country:US
Mailing Address - Phone:732-329-2439
Mailing Address - Fax:
Practice Address - Street 1:380 DEMOTT LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2762
Practice Address - Country:US
Practice Address - Phone:732-873-2000
Practice Address - Fax:732-873-2112
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00172100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant