Provider Demographics
NPI:1992577373
Name:PETTENATI, NOAH (PA-C)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:PETTENATI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MAIN ST
Mailing Address - Street 2:UNIT 405
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:814-771-9403
Mailing Address - Fax:
Practice Address - Street 1:2 UNIVERSITY PLZ STE 500
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6228
Practice Address - Country:US
Practice Address - Phone:201-342-2550
Practice Address - Fax:201-342-7171
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2024-01-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant