Individual
ANTONIO PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17 DODD ST APT A5, BLOOMFIELD, NJ 07003-4626
(973) 931-7705
Mailing address
17 DODD ST APT A5, BLOOMFIELD, NJ 07003-4626
(973) 931-7705
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
11/17/2019
Last updated
11/17/2019
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