Provider Demographics
NPI:1992129159
Name:DR JOSEPH P PEDOTO LLC
Entity type:Organization
Organization Name:DR JOSEPH P PEDOTO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PEDOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-650-4796
Mailing Address - Street 1:30 HOLLAND CIR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1928
Mailing Address - Country:US
Mailing Address - Phone:973-650-4796
Mailing Address - Fax:
Practice Address - Street 1:605 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2859
Practice Address - Country:US
Practice Address - Phone:973-783-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100299100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty