Healthcare Provider Details

I. General information

NPI: 1497616189
Provider Name (Legal Business Name): TRISHAN T PHILLIPS CRANIAL PROSTHESIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 WARD ST
ORANGE NJ
07050-4009
US

IV. Provider business mailing address

86 WARD ST
ORANGE NJ
07050-4009
US

V. Phone/Fax

Practice location:
  • Phone: 201-686-2311
  • Fax:
Mailing address:
  • Phone: 201-686-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number545151938
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: