Provider Demographics
NPI:1265928139
Name:DAFEELLA, AMRO H
Entity type:Individual
Prefix:
First Name:AMRO
Middle Name:H
Last Name:DAFEELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S ORANGE AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1715
Mailing Address - Country:US
Mailing Address - Phone:973-395-2655
Mailing Address - Fax:973-395-2665
Practice Address - Street 1:626 CENTRAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1438
Practice Address - Country:US
Practice Address - Phone:973-395-2655
Practice Address - Fax:973-395-2665
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26-3455033OtherMEDICAL TRANSPORTATION