Provider Demographics
NPI:1043312325
Name:GIANNELLI, JOHN JAY (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAY
Last Name:GIANNELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1170
Mailing Address - Country:US
Mailing Address - Phone:201-424-9775
Mailing Address - Fax:
Practice Address - Street 1:2 NORTH ST STE 1B
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1898
Practice Address - Country:US
Practice Address - Phone:201-857-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00408400111N00000X
NJ40QA00288000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ571975TJ5Medicare ID - Type UnspecifiedPHYSICAL THERAPY MC #