Provider Demographics
NPI:1285081927
Name:PIERRE, WIDNY (DC)
Entity type:Individual
Prefix:DR
First Name:WIDNY
Middle Name:
Last Name:PIERRE
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 1:208 STIRLING AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3029
Mailing Address - Country:US
Mailing Address - Phone:732-595-2444
Mailing Address - Fax:
Practice Address - Street 1:200 CENTENNIAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3950
Practice Address - Country:US
Practice Address - Phone:732-595-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3394NJ174400000X, 246ZE0600X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No174400000XOther Service ProvidersSpecialist
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist