Provider Demographics
NPI:1659385433
Name:WITTIG, CHRISTIAN CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:CHARLES
Last Name:WITTIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARIA LN
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2860
Mailing Address - Country:US
Mailing Address - Phone:973-296-6532
Mailing Address - Fax:973-291-4462
Practice Address - Street 1:3 MARIA LN
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2860
Practice Address - Country:US
Practice Address - Phone:973-296-6532
Practice Address - Fax:973-291-4462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTQA00654300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097678Medicare PIN