Healthcare Provider Details

I. General information

NPI: 1417269358
Provider Name (Legal Business Name): PIERRE M PIERRE LOUIS D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3442 PALACE CT
MERCHANTVILLE NJ
08109-3819
US

IV. Provider business mailing address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

V. Phone/Fax

Practice location:
  • Phone: 856-438-6210
  • Fax:
Mailing address:
  • Phone: 877-832-2652
  • Fax: 800-792-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS11623
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS015229
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: