Provider Demographics
NPI:1538296728
Name:PANNITTI, DIANE (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:PANNITTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3803
Mailing Address - Country:US
Mailing Address - Phone:973-751-3729
Mailing Address - Fax:973-751-4156
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4119
Practice Address - Country:US
Practice Address - Phone:973-751-3729
Practice Address - Fax:973-751-4156
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00100700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3464913OtherOXFORD ID #