Healthcare Provider Details

I. General information

NPI: 1861474512
Provider Name (Legal Business Name): JOANNE E PETRUNIK OT CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MADISON AVE STE 303
MORRISTOWN NJ
07960-7359
US

IV. Provider business mailing address

1259 ROUTE 46 BUILDING #3
PARSIPPANY NJ
07054-4909
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-0991
  • Fax: 973-267-0930
Mailing address:
  • Phone: 973-334-4321
  • Fax: 973-334-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number46TR00297400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: