Provider Demographics
NPI:1205042025
Name:CARINO, MARIJO BRILLANTES (RPT)
Entity Type:Individual
Prefix:
First Name:MARIJO
Middle Name:BRILLANTES
Last Name:CARINO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JOANNE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1921
Mailing Address - Country:US
Mailing Address - Phone:973-379-7876
Mailing Address - Fax:973-762-6207
Practice Address - Street 1:333 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2491
Practice Address - Country:US
Practice Address - Phone:973-313-2104
Practice Address - Fax:973-762-6207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00497400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist