Individual provider · NPI-1

Dereck L Dillard

Home Health Aide · Newark, NJ

NPI number1093015000
StatusActive
Last updated in NPPESMay 5, 2022

Details

NPI
1093015000
Entity type
Individual (NPI-1)
Name
Mr. Dereck L Dillard
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 25, 2010
Certification date
May 5, 2022
Last updated
May 5, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
374U00000X Home Health Aide––Yes

Practice location

870 S Orange Ave
Newark, NJ 07106-1944

Phone 646-355-5583

Mailing address

870 S Orange Ave
Newark, NJ 07106-1944

Phone 646-355-5583

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