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General NPI Number Information
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NPI Number | 1043312325
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Entity Type | Individual
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Provider Name | JOHN JAY GIANNELLI P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 2 NORTH ST STE 1B
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City | WALDWICK
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State | NJ
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Zip | 07463-1898
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Country | US
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Telephone | 201-857-8685
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Fax |
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Provider Business Mailing Address
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Address Line | 152 EVERGREEN RD
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City | RAMSEY
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State | NJ
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Zip | 07446-1170
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Country | US
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Telephone | 201-424-9775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00408400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00288000
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License Number State | NJ
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