| Doctor Name: | THEODORE A PETTI |
| NPI Number: | 1033170121 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 25MA07587000 |
| Business Practice Address: | 671 Hoes Ln University Behavioral Healthcare Room C-202 Piscataway, NJ - 088545627 |
| Business Phone Number: | 7322352129 |
| Business Fax Number: | 7322352101 |
| Mailing Address: | 66 West Gilbert St, RED BANK |
| State: | NJ |
| Postal Code: | 07701 |
| Phone Number: | 7322120051 |
| Fax Number: | 7322120713 |
| NPI Enumeration Date: | 03/29/2006 |
| NPI Last Update Date: | 04/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0804X |
| License Number: | 25MA07587000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Child & Adolescent Psychiatry |
| Taxonomy Definition: | Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |