Provider Demographics
NPI:1366478075
Name:CAMILLONE, JOSEPH JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:CAMILLONE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1028
Mailing Address - Country:US
Mailing Address - Phone:609-771-1393
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNINGTON RD
Practice Address - Street 2:THE COLLEGE OF NEW JERSEY
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1104
Practice Address - Country:US
Practice Address - Phone:609-771-2387
Practice Address - Fax:609-637-5101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000002002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer