MEDICARE: MR. STEPHEN JOSEPH PITTARELLI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00958200	NJ

General Provider Information

NPI Number	:	1144434754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN JOSEPH PITTARELLI PT

Provider Business Mailing Address
First Line	:	7 VIXEN PLACE
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07753-7684
Country	:	US
Telephone Number	:	732-922-1539
Fax Number	:	732-842-1680

Provider Business Practice Location Address
First Line	:	734 NEWMAN'S SPRING RD
Second Line	:
City	:	LINCROFT
State	:	NJ
Zip	:	07738-1523
Country	:	US
Telephone Number	:	732-842-1680
Fax Number	:	732-842-1680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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