Provider Demographics
NPI:1649569773
Name:MAGANTE, JEANNE ROSE O (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE ROSE
Middle Name:O
Last Name:MAGANTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JEANNE ROSE
Other - Middle Name:OBRIQUE
Other - Last Name:MAGANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:278 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2357
Mailing Address - Country:US
Mailing Address - Phone:973-580-9136
Mailing Address - Fax:
Practice Address - Street 1:278 FOREST ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2357
Practice Address - Country:US
Practice Address - Phone:973-580-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2020-08-05
Deactivation Date:2014-07-16
Deactivation Code:
Reactivation Date:2020-08-05
Provider Licenses
StateLicense IDTaxonomies
NY024238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA100076848Medicare PIN