Individual
DR. ILEANA FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
415 AVENEL ST, AVENEL, NJ 07001-1147
(732) 693-6788
(732) 636-7887
Mailing address
415 AVENEL ST, AVENEL, NJ 07001-1147
(732) 693-6788
(732) 636-7887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
40QA01384600
NJ
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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