Provider Demographics
NPI:1467324830
Name:PELLEGRINI, ANTONIO JOHN
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JOHN
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 PAUL BLVD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-4133
Mailing Address - Country:US
Mailing Address - Phone:551-655-7716
Mailing Address - Fax:
Practice Address - Street 1:525 NJ-35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:848-216-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT003424002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer