Individual
JACKITO JUGAN DAITOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
385 TREMONT AVE, EAST ORANGE, NJ 07018-1023
(973) 676-1000
(973) 395-7003
Mailing address
801 WALNUT ST, ROSELLE PARK, NJ 07204-1350
(908) 245-0604
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NN09365100
NJ
Other
Enumeration date
03/01/2006
Last updated
10/22/2012
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