Provider Demographics
NPI:1245663558
Name:RIEGAL, DOREEN ANN (MS)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:ANN
Last Name:RIEGAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DOREEN
Other - Middle Name:ANN
Other - Last Name:CANCILLIERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:7 CENTER ST UNIT 3310
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3824
Mailing Address - Country:US
Mailing Address - Phone:732-859-6151
Mailing Address - Fax:
Practice Address - Street 1:3349 ROUTE 138 BLDG SUITEA
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9671
Practice Address - Country:US
Practice Address - Phone:732-280-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00154200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist