Provider Demographics
NPI:1164612685
Name:JUSKIEWICZ, ANNETTE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIE
Last Name:JUSKIEWICZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:MARIE
Other - Last Name:PORCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:18 NEWARK POMPTON TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-616-4555
Mailing Address - Fax:973-616-3430
Practice Address - Street 1:18 NEWARK POMPTON TURNPIKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-616-4555
Practice Address - Fax:973-616-3430
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
40QA005313002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics