Provider Demographics
NPI:1265782635
Name:NAZZARI, ANTOINETTE C
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:C
Last Name:NAZZARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:NAZZARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:80 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3625
Practice Address - Country:US
Practice Address - Phone:201-265-5010
Practice Address - Fax:201-265-5012
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00609900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist