Individual
JACK BRETT PASSARELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
12 W TAUNTON AVE, BERLIN, NJ 08009-1442
(856) 768-6444
(856) 768-6412
Mailing address
420 CHESTNUT ST, ATCO, NJ 08004-2127
(856) 767-9109
(856) 767-9109
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT00278700
NJ
Other
Enumeration date
08/01/2017
Last updated
03/17/2018
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