Provider Demographics
NPI:1871784413
Name:THILLET, JULIO MANUEL (LPN)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:MANUEL
Last Name:THILLET
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E 230TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4103
Mailing Address - Country:US
Mailing Address - Phone:718-380-3000
Mailing Address - Fax:718-969-5857
Practice Address - Street 1:8115 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1118
Practice Address - Country:US
Practice Address - Phone:718-380-3000
Practice Address - Fax:718-969-5857
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5310583164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse