Healthcare Provider Details

I. General information

NPI: 1306865613
Provider Name (Legal Business Name): DAVID D. PICASCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SCHANCK RD SUITE B-3
FREEHOLD NJ
07728-2964
US

IV. Provider business mailing address

7 RAINTREE CT
HOLMDEL NJ
07733-2814
US

V. Phone/Fax

Practice location:
  • Phone: 732-462-9800
  • Fax: 732-308-1647
Mailing address:
  • Phone: 732-842-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMA51607
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: