MEDICARE: JOSEPH J. PETRIELLO III 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	40QA01263200	NJ

General Provider Information

NPI Number	:	1235315573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH J. PETRIELLO III PT

Provider Business Mailing Address
First Line	:	47 FULTON ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2227
Country	:	US
Telephone Number	:	201-230-5932
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 UNION AVE UNIT 4
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-2009
Country	:	US
Telephone Number	:	201-347-9459
Fax Number	:	201-623-2584

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	12/22/2022

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