Provider Demographics
NPI:1093513491
Name:TOBON-MARIN, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:TOBON-MARIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3247
Mailing Address - Country:US
Mailing Address - Phone:201-981-1626
Mailing Address - Fax:
Practice Address - Street 1:251 W ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3247
Practice Address - Country:US
Practice Address - Phone:201-981-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01515900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist