Provider Demographics
NPI:1316013378
Name:DON A JANNICELLI, PT
Entity Type:Organization
Organization Name:DON A JANNICELLI, PT
Other - Org Name:BLOOMFIELD INST PHY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRANKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-680-1971
Mailing Address - Street 1:230 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2606
Mailing Address - Country:US
Mailing Address - Phone:973-680-1971
Mailing Address - Fax:973-680-4837
Practice Address - Street 1:230 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2606
Practice Address - Country:US
Practice Address - Phone:973-680-1971
Practice Address - Fax:973-680-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00135900174400000X, 261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJA617099Medicare PIN
NJ=========Medicare UPIN