Individual
JESUS CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1070 CLIFTON AVE, SUITE 1A, CLIFTON, NJ 07013-3619
(973) 246-6565
(973) 883-0140
Mailing address
9 LOCUST PL, LIVINGSTON, NJ 07039-1212
(973) 413-9936
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00474700
NJ
Other
Enumeration date
10/06/2011
Last updated
10/06/2011
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