Provider Demographics
NPI:1891403549
Name:ANNESE, AMY (PT)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:ANNESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LIVINGSTON ST STE 108
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1739
Mailing Address - Country:US
Mailing Address - Phone:201-564-7515
Mailing Address - Fax:201-564-7514
Practice Address - Street 1:1 VAN WYCK ST
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1025
Practice Address - Country:US
Practice Address - Phone:551-804-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02135600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA02135600OtherPHYSICAL THERAPY NJ LICENSE