Healthcare Provider Details

I. General information

NPI: 1750321808
Provider Name (Legal Business Name): KELLY IORILLO RD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY JANUZZI RD, MS

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

1050 GALLOPING HILL RD
UNION NJ
07083-7983
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7073
  • Fax: 973-322-7528
Mailing address:
  • Phone: 908-206-2230
  • Fax: 908-206-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number852504
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: