Provider Demographics
NPI:1689778995
Name:PENNETT, DONALD T (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:T
Last Name:PENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 WESCOTT DR STE 205
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4600
Mailing Address - Country:US
Mailing Address - Phone:908-788-6555
Mailing Address - Fax:908-237-2372
Practice Address - Street 1:1100 WESCOTT DR STE 205
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4600
Practice Address - Country:US
Practice Address - Phone:908-788-6555
Practice Address - Fax:908-237-2372
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA043419002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1220403Medicaid
566014Medicare PIN
E23850Medicare UPIN