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Individual

EDWIN RAFAEL FERNANDEZ GRULLON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
47 BAYSIDE DR, BAYONNE, NJ 07002-1278
(239) 298-6665
Mailing address
47 BAYSIDE DR, BAYONNE, NJ 07002-1278
(239) 298-6665

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09163500
NJ

Other

Enumeration date
04/03/2019
Last updated
04/04/2019
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