Individual
JEANCLAUDE JEANLYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
147 CLEVELAND ST, ORANGE, NJ 07050-2749
(201) 463-4356
Mailing address
147 CLEVELAND ST, ORANGE, NJ 07050-2749
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
310163
NY
Other
Enumeration date
01/17/2013
Last updated
01/17/2013
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