Provider Demographics
NPI:1598741282
Name:KILYK, DOUGLAS S (OT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:S
Last Name:KILYK
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-4050
Mailing Address - Country:US
Mailing Address - Phone:848-459-7267
Mailing Address - Fax:
Practice Address - Street 1:758 HIGHWAY 18
Practice Address - Street 2:STE 106
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4910
Practice Address - Country:US
Practice Address - Phone:732-254-0090
Practice Address - Fax:732-254-2292
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00147600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078365SQJMedicare ID - Type Unspecified
Q14067Medicare UPIN