Provider Demographics
NPI:1386367415
Name:PANTINA, ROCCO (DPT)
Entity type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:
Last Name:PANTINA
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 BROAD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3066
Mailing Address - Country:US
Mailing Address - Phone:877-532-7837
Mailing Address - Fax:
Practice Address - Street 1:300 PERRINE RD STE 315
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3628
Practice Address - Country:US
Practice Address - Phone:732-838-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02129300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4OQA02129300OtherLICENSE