Provider Demographics
NPI:1043318785
Name:SCORDILIS, PETER J (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:SCORDILIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BROADACRES DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3153
Mailing Address - Country:US
Mailing Address - Phone:973-473-4481
Mailing Address - Fax:973-893-8259
Practice Address - Street 1:300 BROADACRES DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3153
Practice Address - Country:US
Practice Address - Phone:973-473-4481
Practice Address - Fax:973-893-8259
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00645800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100063UOPMedicare ID - Type Unspecified