Provider Demographics
NPI:1083179139
Name:COL, TRIFF SANTEE BOQUILON (DPT)
Entity Type:Individual
Prefix:
First Name:TRIFF SANTEE
Middle Name:BOQUILON
Last Name:COL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 EDMUND TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4006
Mailing Address - Country:US
Mailing Address - Phone:908-265-7071
Mailing Address - Fax:
Practice Address - Street 1:4800 BROADWAY STE 212
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6544
Practice Address - Country:US
Practice Address - Phone:877-576-4681
Practice Address - Fax:888-503-1237
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01838000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist