Healthcare Provider Details

I. General information

NPI: 1477213106
Provider Name (Legal Business Name): PATIENT CARE SPECIALTY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MAIN ST
EDISON NJ
08837-3418
US

IV. Provider business mailing address

PO BOX 825829
PHILADELPHIA PA
19182-5829
US

V. Phone/Fax

Practice location:
  • Phone: 609-385-2622
  • Fax:
Mailing address:
  • Phone: 609-521-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW PECORA
Title or Position: DO
Credential: DO
Phone: 609-521-4746