Provider Demographics
NPI:1619460441
Name:VONITTER, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VONITTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNELLEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812-1641
Practice Address - Country:US
Practice Address - Phone:908-202-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer