Healthcare Provider Details

I. General information

NPI: 1376637553
Provider Name (Legal Business Name): ANDREW PAUL PECORA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 N MAPLE AVE STE B
MARLTON NJ
08053-1782
US

IV. Provider business mailing address

73 N MAPLE AVE STE B
MARLTON NJ
08053-1782
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-0558
  • Fax: 856-596-4043
Mailing address:
  • Phone: 856-596-0558
  • Fax: 856-596-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB05694000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: