Healthcare Provider Details

I. General information

NPI: 1669181566
Provider Name (Legal Business Name): DILLON YASSER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 OCEANPORT AVENUE, BLDG. 2
LITTLE SILVER NJ
07739-1250
US

IV. Provider business mailing address

116 OCEANPORT AVENUE, BLDG. 2
LITTLE SILVER NJ
07739-1250
US

V. Phone/Fax

Practice location:
  • Phone: 732-758-0002
  • Fax: 732-219-0979
Mailing address:
  • Phone: 732-758-0002
  • Fax: 732-219-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02138300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: