Provider Demographics
NPI:1376770420
Name:FULOP, JACLYN H (PT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:H
Last Name:FULOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:535 CENTERVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4376
Mailing Address - Country:US
Mailing Address - Phone:401-737-6011
Mailing Address - Fax:401-737-4811
Practice Address - Street 1:500 AVE AT PORT IMPERIAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-6960
Practice Address - Country:US
Practice Address - Phone:201-272-9400
Practice Address - Fax:201-272-9402
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01352600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist