Provider Demographics
NPI:1689625915
Name:PAGNOTTA, PAT (DC)
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:
Last Name:PAGNOTTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHELSEA AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741-1409
Mailing Address - Country:US
Mailing Address - Phone:732-341-5954
Mailing Address - Fax:732-341-5955
Practice Address - Street 1:101 CHELSEA AVE
Practice Address - Street 2:
Practice Address - City:PINE BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08741-1409
Practice Address - Country:US
Practice Address - Phone:732-341-5954
Practice Address - Fax:732-341-5955
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00318900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ811154648OtherTAX IDENTIFICATION NUMBER