Provider Demographics
NPI:1003327727
Name:BOTTINI, JAQUILO D
Entity Type:Individual
Prefix:
First Name:JAQUILO
Middle Name:D
Last Name:BOTTINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 PALISADE AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3129
Mailing Address - Country:US
Mailing Address - Phone:973-955-9118
Mailing Address - Fax:201-357-5478
Practice Address - Street 1:764 PALISADE AVE STE 2B
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3129
Practice Address - Country:US
Practice Address - Phone:973-955-9118
Practice Address - Fax:201-537-5478
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH11329800163WH0200X
NJ26NR16772500163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health