Provider Demographics
NPI:1114316031
Name:IANNELLI, JOHN CARMEN JR (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARMEN
Last Name:IANNELLI
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 N TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3459
Mailing Address - Country:US
Mailing Address - Phone:856-237-7467
Mailing Address - Fax:856-716-6525
Practice Address - Street 1:1165 N TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3459
Practice Address - Country:US
Practice Address - Phone:856-237-7467
Practice Address - Fax:856-716-6525
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003262225100000X
NJ40QA01800800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist