Individual
DR. JACK ANNUNZIATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1200 E RIDGEWOOD AVE STE 306, RIDGEWOOD, NJ 07450-3937
(201) 612-4857
Mailing address
1200 E RIDGEWOOD AVE STE 306, RIDGEWOOD, NJ 07450-3937
(201) 612-4857
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
25MB10536200
NJ
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25MB10536200
NJ
390200000X
Student in an Organized Health Care Education/Training Program
OT016359
PA
Other
Enumeration date
06/05/2015
Last updated
04/28/2021
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