Provider Demographics
NPI:1265611222
Name:PATRICIA N IANNOTTA MD LLC
Entity type:Organization
Organization Name:PATRICIA N IANNOTTA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:IANNOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-651-0009
Mailing Address - Street 1:SUITE E
Mailing Address - Street 2:6 AUER CT
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5828
Mailing Address - Country:US
Mailing Address - Phone:732-651-0009
Mailing Address - Fax:
Practice Address - Street 1:SUITE E
Practice Address - Street 2:6 AUER CT
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5828
Practice Address - Country:US
Practice Address - Phone:732-651-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086615Medicare PIN