Healthcare Provider Details

I. General information

NPI: 1376405183
Provider Name (Legal Business Name): TONI A PETIONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVE STE 215
PARAMUS NJ
07652-5245
US

IV. Provider business mailing address

335 LIBERTY RD
ENGLEWOOD NJ
07631-2108
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-5145
  • Fax:
Mailing address:
  • Phone: 201-286-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15390000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: