Provider Demographics
NPI:1134509375
Name:CASTILLO- PARRIS, DORIS
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:CASTILLO- PARRIS
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 1:262 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-1636
Mailing Address - Country:US
Mailing Address - Phone:973-767-7848
Mailing Address - Fax:
Practice Address - Street 1:101 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1167
Practice Address - Country:US
Practice Address - Phone:973-928-1950
Practice Address - Fax:973-928-1951
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00056600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist