Individual
DR. JUAN GUILLERMO VAILLANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
40 THROCKMORTON LN, OLD BRIDGE, NJ 08857-2520
(732) 679-0222
Mailing address
123 HAMPTON AVE, BROOKLYN, NY 11235-4132
(718) 891-9373
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
134403
NY
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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