Provider Demographics
NPI:1659502235
Name:FEBRILLET, JOSE PABLO (R-PA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:PABLO
Last Name:FEBRILLET
Suffix:
Gender:M
Credentials:R-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5640
Mailing Address - Country:US
Mailing Address - Phone:917-837-4210
Mailing Address - Fax:
Practice Address - Street 1:3410 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7400
Practice Address - Country:US
Practice Address - Phone:201-299-4758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013287-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant