Provider Demographics
NPI:1043671639
Name:TELLO, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:TELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ROUTE 73 S STE 301
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4191
Mailing Address - Country:US
Mailing Address - Phone:609-601-4920
Mailing Address - Fax:856-291-6503
Practice Address - Street 1:750 ROUTE 73 S STE 301
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4191
Practice Address - Country:US
Practice Address - Phone:609-601-4920
Practice Address - Fax:856-291-6503
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist