Individual
JOSE LUIS MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 W 53RD ST APT 26, BAYONNE, NJ 07002-3356
(718) 761-9800
Mailing address
106 W 53RD ST APT 26, BAYONNE, NJ 07002-3356
(718) 761-9800
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/15/2011
Last updated
11/15/2011
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