Provider Demographics
NPI:1053580498
Name:ISIDRO, ARWIN (PT)
Entity type:Individual
Prefix:MR
First Name:ARWIN
Middle Name:
Last Name:ISIDRO
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 1:165 VROOM ST
Mailing Address - Street 2:APT 4G
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4539
Mailing Address - Country:US
Mailing Address - Phone:201-988-6342
Mailing Address - Fax:201-433-3565
Practice Address - Street 1:165 VROOM ST
Practice Address - Street 2:APT 4G
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4539
Practice Address - Country:US
Practice Address - Phone:201-988-6342
Practice Address - Fax:201-433-3565
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01050800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist