Provider Demographics
NPI:1376598649
Name:DENINO, PETER JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:DENINO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 STATE HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3049
Mailing Address - Country:US
Mailing Address - Phone:732-202-1200
Mailing Address - Fax:732-202-1300
Practice Address - Street 1:1645 STATE HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3049
Practice Address - Country:US
Practice Address - Phone:732-202-1200
Practice Address - Fax:732-202-1300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC003514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520636PYHMedicare ID - Type Unspecified
NJT87629Medicare UPIN