Individual
JERRY DORESTANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
709 POWELL ST, GLOUCESTER CITY, NJ 08030-2045
(786) 689-0573
Mailing address
709 POWELL ST, GLOUCESTER CITY, NJ 08030-2045
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/27/2026
Last updated
02/27/2026
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