Healthcare Provider Details

I. General information

NPI: 1780001438
Provider Name (Legal Business Name): JOANNE PAVENTA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MARKET ST SUITE 5
SADDLE BROOK NJ
07663-5996
US

IV. Provider business mailing address

444 MARKET ST SUITE 5
SADDLE BROOK NJ
07663-5996
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-8300
  • Fax: 201-843-7833
Mailing address:
  • Phone: 201-843-8300
  • Fax: 201-843-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA00648700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: