Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40QA00619000 | NJ |
NPI | 1053538249 |
---|---|
Provider Name | Keith W Pidane |
First Address | Mountainside, NJ 07092-2590 |
Second Address | Mountainside, NJ 07092-2590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |