Provider Demographics
NPI:1023042918
Name:BRILLON, ALBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:BRILLON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1412
Mailing Address - Country:US
Mailing Address - Phone:877-887-3574
Mailing Address - Fax:
Practice Address - Street 1:88 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1412
Practice Address - Country:US
Practice Address - Phone:877-887-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00784500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095538Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID NO.