Provider Demographics
NPI:1053776583
Name:VOLTAIRE BERMUDO CONSULTING AND PHYSICAL THERAPY, LLC.
Entity type:Organization
Organization Name:VOLTAIRE BERMUDO CONSULTING AND PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VOLTAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-696-6193
Mailing Address - Street 1:9 BROWNSTONE WAY
Mailing Address - Street 2:APT 419
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1213
Mailing Address - Country:US
Mailing Address - Phone:201-696-6193
Mailing Address - Fax:
Practice Address - Street 1:560 SYLVAN AVE
Practice Address - Street 2:STE 1270
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3119
Practice Address - Country:US
Practice Address - Phone:201-696-6193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01383000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ102614Medicare UPIN