Provider Demographics
NPI:1104961564
Name:VISCO, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VISCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 ROUTE 66 FL 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-807-0880
Mailing Address - Fax:
Practice Address - Street 1:436 CHRIS GAUPP DR STE 204
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4488
Practice Address - Country:US
Practice Address - Phone:609-748-4000
Practice Address - Fax:609-652-7616
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425526207RC0200X
NJ25MA08353400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine