Provider Demographics
NPI:1528750262
Name:VANNOY, DUANE (PTA)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:VANNOY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ROCKLAND TER APT 3
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1608
Mailing Address - Country:US
Mailing Address - Phone:862-210-4452
Mailing Address - Fax:
Practice Address - Street 1:300 EXECUTIVE DR STE 10
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3383
Practice Address - Country:US
Practice Address - Phone:973-243-6299
Practice Address - Fax:973-325-2590
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00347800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant