1902966427 NPI number — DR. TESSA MYRA CANTADO ALMEDA DPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902966427 NPI number — DR. TESSA MYRA CANTADO ALMEDA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALMEDA
Provider First Name:
TESSA MYRA
Provider Middle Name:
CANTADO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANTADO
Provider Other First Name:
TESSA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902966427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
743 NORTHFIELD AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-669-8300
Provider Business Mailing Address Fax Number:
973-669-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
743 NORTHFIELD AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-1158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-669-8300
Provider Business Practice Location Address Fax Number:
973-669-8333
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT40QA01003600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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