Individual
MR. VANCE VILLASTRIGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 AIRPORT RD, LAKEWOOD, NJ 08701-5907
(732) 367-4700
Mailing address
PO BOX 2036, LAKEWOOD, NJ 08701-8036
(732) 367-4700
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
261QM0801X
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
08/08/2022
Last updated
08/08/2022
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