Edwin Rafael Fernandez Grullon

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

46TA09163500 Issued in NJ

Practice address

47 Bayside Dr
Bayonne, NJ 07002-1278

Phone

(239) 298-6665

NPI assigned

Apr 3, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1912469321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 BAYSIDE DR",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070021278",
            "telephone_number": "239-298-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 BAYSIDE DR",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070021278",
            "telephone_number": "239-298-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ GRULLON",
        "first_name": "EDWIN",
        "middle_name": "RAFAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-03",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NJ",
            "license": "46TA09163500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fast Track Services LLC
• Recisa Dale Fearon, APN
• Arlene Macariola Federal, P.T.
• Michael Fedorovsky, D.O.
• David Michael Feniger, P.T.
• Homero Ferreira Da Silva Neto
• Gerrard F.a. Ferrer, D.O.
• Jordan Fersel, M.D.
• Gerard A Figurelli, PH.D.
• Tiesha Finley, PHD

• Occupational Therapy Assistant in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Occupational Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.