Provider Demographics
NPI:1548042070
Name:JEAN LOUIS-CAMILLE, SERGELYNE
Entity type:Individual
Prefix:
First Name:SERGELYNE
Middle Name:
Last Name:JEAN LOUIS-CAMILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SUMMIT AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3172
Mailing Address - Country:US
Mailing Address - Phone:718-926-7739
Mailing Address - Fax:
Practice Address - Street 1:300 COLES ST STE 305
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1045
Practice Address - Country:US
Practice Address - Phone:718-926-7739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18K01316700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist