Provider Demographics
NPI:1679680854
Name:PICONE, MORINE JULIA (AT, PTA)
Entity Type:Individual
Prefix:
First Name:MORINE
Middle Name:JULIA
Last Name:PICONE
Suffix:
Gender:F
Credentials:AT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OLD SHORT HILLS RD
Mailing Address - Street 2:APT. 369
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1009
Mailing Address - Country:US
Mailing Address - Phone:973-325-5626
Mailing Address - Fax:
Practice Address - Street 1:600 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5419
Practice Address - Country:US
Practice Address - Phone:973-992-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00160600225200000X
NJ25MT000560002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer