Provider Demographics
NPI:1699744755
Name:PECORELLI, NICHOLAS T (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:T
Last Name:PECORELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD-RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1236
Mailing Address - Country:US
Mailing Address - Phone:201-438-5500
Mailing Address - Fax:201-438-3363
Practice Address - Street 1:245 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WOOD-RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-1236
Practice Address - Country:US
Practice Address - Phone:201-438-5500
Practice Address - Fax:201-438-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06462500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP867458OtherOXFORD
NJ5151665OtherAETNA PPO
NJ7088407Medicaid
NJ8097769OtherCIGNA HMO
NJ1K5877OtherHEALTHNET
NJ110207170OtherRR MEDICARE
NJ223736874OtherTIN,HORIZON
NJ8097769OtherCIGNA HMO
NJ110207170OtherRR MEDICARE