Provider Demographics
NPI:1306055587
Name:OLMILLA, JOCELYN OMANDAC (PT)
Entity type:Individual
Prefix:MISS
First Name:JOCELYN
Middle Name:OMANDAC
Last Name:OLMILLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1118
Mailing Address - Country:US
Mailing Address - Phone:201-244-6556
Mailing Address - Fax:
Practice Address - Street 1:221 COUNTY RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1605
Practice Address - Country:US
Practice Address - Phone:201-227-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01079500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist