Provider Demographics
NPI:1265760573
Name:TRILLING, JUSTIN (DPT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:TRILLING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 EAGLE ROCK AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4229
Mailing Address - Country:US
Mailing Address - Phone:718-979-1616
Mailing Address - Fax:718-979-4906
Practice Address - Street 1:414 EAGLE ROCK AVE
Practice Address - Street 2:STE 107
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4229
Practice Address - Country:US
Practice Address - Phone:973-731-7877
Practice Address - Fax:973-731-6332
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030726-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist