Provider Demographics
NPI:1235315573
Name:PETRIELLO, JOSEPH J III (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:PETRIELLO
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2227
Mailing Address - Country:US
Mailing Address - Phone:201-230-5932
Mailing Address - Fax:
Practice Address - Street 1:111 UNION AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2009
Practice Address - Country:US
Practice Address - Phone:201-347-9459
Practice Address - Fax:201-623-2584
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01263200225100000X
NJ40AQA01263200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist