Provider Demographics
NPI:1407263098
Name:HAVRILLA, ANDREW (RRT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HAVRILLA
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-2124
Mailing Address - Country:US
Mailing Address - Phone:973-607-7259
Mailing Address - Fax:
Practice Address - Street 1:3 SUNNY LN
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-2124
Practice Address - Country:US
Practice Address - Phone:973-607-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43ZA00614200227900000X
PAYM014419227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered