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NPI Code Detail

MEDICARE: MISS JOCELYN OMANDAC OLMILLA PT

MEDICARE: MISS JOCELYN OMANDAC OLMILLA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA01079500NJ

General Provider Information

NPI Number : 1306055587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JOCELYN OMANDAC OLMILLA PT
Provider Business Mailing Address
First Line : 7812 95TH AVE
Second Line :
City : OZONE PARK
State : NY
Zip : 11416-1118
Country : US
Telephone Number : 201-244-6556
Fax Number :
Provider Business Practice Location Address
First Line : 221 COUNTY RD
Second Line :
City : CRESSKILL
State : NJ
Zip : 07626-1605
Country : US
Telephone Number : 201-227-5703
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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