Individual
THEODORE A PETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
671 HOES LN, UNIVERSITY BEHAVIORAL HEALTHCARE ROOM C-202, PISCATAWAY, NJ 08854-5627
(732) 235-2129
(732) 235-2101
Mailing address
66 WEST GILBERT ST, RED BANK, NJ 07701
(732) 212-0051
(732) 212-0713
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
25MA07587000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013382
—
NJ
Enumeration date
03/29/2006
Last updated
04/03/2008
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