Healthcare Provider Details

I. General information

NPI: 1265611222
Provider Name (Legal Business Name): PATRICIA N IANNOTTA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE E 6 AUER CT
EAST BRUNSWICK NJ
08816-5828
US

IV. Provider business mailing address

SUITE E 6 AUER CT
EAST BRUNSWICK NJ
08816-5828
US

V. Phone/Fax

Practice location:
  • Phone: 732-651-0009
  • Fax:
Mailing address:
  • Phone: 732-651-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA N IANNOTTA
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 732-651-0009