Basic Information
| Provider Information | |||||||||
| NPI: | 1891943387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNINGER | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MATIAS | ||||||||
| OtherFirstName: | MARJORIE | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11 EAGLE ROCK AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EAST HANOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079363101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738879000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 43 OLD BLOOMFIELD AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNTAIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070461429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734021600 | ||||||||
| FaxNumber: | 9734021770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 03/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01288800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.