Provider Demographics
NPI:1558413617
Name:ESTAVILLO, AILEEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:C
Last Name:ESTAVILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:ESTAVILLO-ESTILO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 SPRUCE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3100
Mailing Address - Country:US
Mailing Address - Phone:732-521-5285
Mailing Address - Fax:
Practice Address - Street 1:281 ROUTE 34 STE 813
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2440
Practice Address - Country:US
Practice Address - Phone:732-431-4620
Practice Address - Fax:732-431-3707
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07873500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI27454Medicare UPIN