1629040084 NPI number — LAURA S PICCIANO M.D.

Table of content: LAURA S PICCIANO M.D. (NPI 1629040084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629040084 NPI number — LAURA S PICCIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICCIANO
Provider First Name:
LAURA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629040084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E. LANCASTER AVE.
Provider Second Line Business Mailing Address:
SUITE 330 MOB WEST
Provider Business Mailing Address City Name:
WYNNEWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19096-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-645-6555
Provider Business Mailing Address Fax Number:
610-649-4744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 MAIN STREET
Provider Second Line Business Practice Location Address:
THE RIPA CENTER
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-673-4912
Provider Business Practice Location Address Fax Number:
856-938-2077
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS009621L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MB07361900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0017809080001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com