Provider Demographics
NPI:1184315673
Name:CALANDRILLO, BART (MASAAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:BART
Middle Name:
Last Name:CALANDRILLO
Suffix:
Gender:M
Credentials:MASAAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 INNES RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075
Mailing Address - Country:US
Mailing Address - Phone:201-723-2609
Mailing Address - Fax:
Practice Address - Street 1:447 INNES RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075
Practice Address - Country:US
Practice Address - Phone:201-723-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01071400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist