DR. ILEANA FAJARDO D.P.T. - NPI 1194004275

Q: What is the provider's specialty?

The provider's specialty is Specialist with taxonomy code 174400000X.

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About Dr. Ileana Fajardo D.p.t. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ILEANA FAJARDO D.P.T. (NPI 1194004275) is an individual specialist in Avenel, New Jersey, licensed in New Jersey (40QA01384600) and active in the NPI registry since August 2011.

NPPES Registry Identity

NPI1194004275

Entity TypeIndividualFemale

Primary Taxonomy174400000X

Provider Legal NameDR. ILEANA FAJARDOCredential: D.P.T.

Location Address415 AVENEL STAvenel, NJ 07001-1147

Mailing Address415 Avenel StAvenel, NJ 07001-1147 · (732) 693-6788 · Fax (732) 636-7887

Phone(732) 693-6788

Fax(732) 636-7887

Sole ProprietorNo

Enumeration DateAugust 8, 2011

✔ NPI 1194004275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in NJ · 40QA01384600

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

415 AVENEL ST, Avenel, NJ 07001

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