Healthcare Provider Details

I. General information

NPI: 1255435269
Provider Name (Legal Business Name): RANDALL EUGENE PITONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 CARMEL ROAD
MILLVILLE NJ
08332
US

IV. Provider business mailing address

2038 CARMEL ROAD
MILLVILLE NJ
08332
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-6810
  • Fax: 856-765-0252
Mailing address:
  • Phone: 856-825-6810
  • Fax: 856-765-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101058768
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31033
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA07963400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: