Provider Demographics
NPI:1699822817
Name:IMBROGNO, LORETTA A (DC)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:A
Last Name:IMBROGNO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PLYMOUTH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4051
Mailing Address - Country:US
Mailing Address - Phone:973-783-0444
Mailing Address - Fax:973-783-4428
Practice Address - Street 1:33 PLYMOUTH ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:973-783-0444
Practice Address - Fax:973-783-4428
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00415400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223556485OtherFED. TAX I.D. #
NJ223556485OtherFED. TAX I.D. #
NJU45673Medicare UPIN