Basic Information
Provider Information
NPI: 1578652186
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARABETI
FirstName: MEREDITH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MACKIE
OtherFirstName: MEREDITH
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 1
Mailing Information
Address1: 11 EAGLE ROCK AVE
Address2: SUITE 201
City: EAST HANOVER
State: NJ
PostalCode: 079363167
CountryCode: US
TelephoneNumber: 9738879000
FaxNumber: 9738873816
Practice Location
Address1: 4253 US HIGHWAY 9
Address2: BLDG 4 UNIT A
City: FREEHOLD
State: NJ
PostalCode: 077288309
CountryCode: US
TelephoneNumber: 7327809033
FaxNumber: 7327808680
Other Information
ProviderEnumerationDate: 10/12/2006
LastUpdateDate: 02/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA00886200NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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