Basic Information
| Provider Information | |||||||||
| NPI: | 1376770420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FULOP | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMPSON | ||||||||
| OtherFirstName: | JACLYN | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 535 CENTERVILLE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017376011 | ||||||||
| FaxNumber: | 4017374811 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 AVE AT PORT IMPERIAL BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | WEEHAWKEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070866960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012729400 | ||||||||
| FaxNumber: | 2012729402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2009 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01352600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.