Basic Information
| Provider Information | |||||||||
| NPI: | 1629663786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURCHLA | ||||||||
| FirstName: | MAGDALENA | ||||||||
| MiddleName: | ALEKSANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 BLAKE DR | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084631174 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 MORRIS AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070811032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733797006 | ||||||||
| FaxNumber: | 9733797007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2021 | ||||||||
| LastUpdateDate: | 04/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 025449 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 46TR00977500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.