Provider Demographics
NPI:1215957246
Name:PICCIANO, MARIA VIEIRA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VIEIRA
Last Name:PICCIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 THAYER CT
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1703
Mailing Address - Country:US
Mailing Address - Phone:973-377-2974
Mailing Address - Fax:
Practice Address - Street 1:36 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1665
Practice Address - Country:US
Practice Address - Phone:973-578-4808
Practice Address - Fax:973-578-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5473403Medicaid
NJF48621Medicare UPIN
NJ480631Medicare ID - Type Unspecified
NJ5473403Medicaid