Healthcare Provider Details

I. General information

NPI: 1295066181
Provider Name (Legal Business Name): PETER JOSEPH SACCONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD STE 201
LINWOOD NJ
08221-1281
US

IV. Provider business mailing address

42 E LAUREL RD SUITE 3100
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 609-788-8593
  • Fax: 609-904-6929
Mailing address:
  • Phone: 856-566-6859
  • Fax: 856-566-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04509
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04509
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB0902500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number04509
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MB09025200
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB09025200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: