Healthcare Provider Details

I. General information

NPI: 1780743138
Provider Name (Legal Business Name): JOHN D.PILLA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N. WASHINGTON AVE
GREEN BROOK NJ
08812-2619
US

IV. Provider business mailing address

PO BOX 845
GREEN BROOK NJ
08812-2619
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-1217
  • Fax: 732-968-4898
Mailing address:
  • Phone: 732-968-1217
  • Fax: 732-968-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN D. PILLA
Title or Position: DIRECTOR
Credential: MD
Phone: 732-968-8900