Provider Demographics
NPI:1700577228
Name:PELLEGRINO, TONI M (LPAT)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WICKLOW DR
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8668
Mailing Address - Country:US
Mailing Address - Phone:609-351-5451
Mailing Address - Fax:
Practice Address - Street 1:34 WICKLOW DR
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-8668
Practice Address - Country:US
Practice Address - Phone:609-351-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00007000221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty