Provider Demographics
NPI:1780001438
Name:PAVENTA, JOANNE (PT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:PAVENTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MARKET ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5996
Mailing Address - Country:US
Mailing Address - Phone:201-843-8300
Mailing Address - Fax:201-843-7833
Practice Address - Street 1:444 MARKET ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5996
Practice Address - Country:US
Practice Address - Phone:201-843-8300
Practice Address - Fax:201-843-7833
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00648700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy