Healthcare Provider Details

I. General information

NPI: 1639084809
Provider Name (Legal Business Name): DOMINIQUE ALENA ADORNETTO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YATES PLAZA, 1572 US-206 SUITE 4
TABERNACLE NJ
08088
US

IV. Provider business mailing address

8 GLEN LAKE DR
MEDFORD NJ
08055-3104
US

V. Phone/Fax

Practice location:
  • Phone: 609-388-4391
  • Fax:
Mailing address:
  • Phone: 609-388-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40QA02428500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: