Individual
MR. TEDDY SECILLANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
9020 WALL ST, NORTH BERGEN, NJ 07047-6011
(201) 861-4040
Mailing address
321 PROSPECT AVE., APT 5D, HACKENSACK, NJ 07601-2593
(718) 404-4462
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
40QA01420100
NJ
2251X0800X
Orthopedic Physical Therapist
40QA01420100
NJ
Other
Enumeration date
04/20/2012
Last updated
04/20/2012
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