Provider Demographics
NPI:1043556640
Name:DEJESUS, DANIELLE ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NORTH COUNTY LINE RD.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2548
Mailing Address - Country:US
Mailing Address - Phone:732-581-9415
Mailing Address - Fax:
Practice Address - Street 1:19 N COUNTY LINE RD.
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2548
Practice Address - Country:US
Practice Address - Phone:732-581-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00086200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist