| Doctor Name: | KEITH W PIDANE |
| NPI Number: | 1053538249 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT,MS,PCS |
| License Number: | 40QA00619000 |
| Business Practice Address: | 150 New Providence Rd Mountainside, NJ - 070922590 |
| Business Phone Number: | 9083895651 |
| Business Fax Number: | |
| Mailing Address: | 150 New Providence Rd, MOUNTAINSIDE |
| State: | NJ |
| Postal Code: | 070922590 |
| Phone Number: | 9083895651 |
| Fax Number: | |
| NPI Enumeration Date: | 04/19/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 40QA00619000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |