Provider Demographics
NPI:1013230127
Name:KING, JANELLE DIANA (LMT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:DIANA
Last Name:KING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GODWIN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-5200
Mailing Address - Country:US
Mailing Address - Phone:973-960-8222
Mailing Address - Fax:
Practice Address - Street 1:260 GODWIN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-5200
Practice Address - Country:US
Practice Address - Phone:973-960-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00206100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist