Healthcare Provider Details

I. General information

NPI: 1003752486
Provider Name (Legal Business Name): JUSTIN KLEIN MURILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 KINGS HWY
BROOKLYN NY
11223-2235
US

IV. Provider business mailing address

856 GREENE AVE APT 1L
BROOKLYN NY
11221-5927
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: