Provider Demographics
NPI:1356434286
Name:PINEDA-LALOG, JENNELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNELLE
Middle Name:
Last Name:PINEDA-LALOG
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 1:24 BOOKER STREET
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2619
Mailing Address - Country:US
Mailing Address - Phone:201-822-0100
Mailing Address - Fax:201-822-0107
Practice Address - Street 1:24 BOOKER STREET
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-822-0100
Practice Address - Fax:201-822-0107
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00464500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6268160OtherCIGNA
NJ1356434286OtherNPI
NJ4620425OtherAETNA PROVIDER #
NJ101491103OtherUS POSTAL/DEPT OF LABOR
NJP3654688OtherOXFORD