Provider Demographics
NPI:1821226366
Name:DEGIDIO, JANA
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:
Last Name:DEGIDIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1112
Mailing Address - Country:US
Mailing Address - Phone:973-943-8741
Mailing Address - Fax:973-921-1997
Practice Address - Street 1:27 WILLOW ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1112
Practice Address - Country:US
Practice Address - Phone:973-943-8741
Practice Address - Fax:973-921-1997
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist