Provider Demographics
NPI:1023570124
Name:SORRENTINO, JILLIAN
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SORRENTINO
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 1:1930 ROUTE 35 N APT 3
Mailing Address - Street 2:
Mailing Address - City:SEASIDE HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08751-1279
Mailing Address - Country:US
Mailing Address - Phone:201-602-9283
Mailing Address - Fax:
Practice Address - Street 1:160 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1103
Practice Address - Country:US
Practice Address - Phone:718-437-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023509225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics