Healthcare Provider Details

I. General information

NPI: 1619612470
Provider Name (Legal Business Name): COURTNEY PIVKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON AVE STE 405
MORRISTOWN NJ
07960-7305
US

IV. Provider business mailing address

8 CHAMBERS PL
RANDOLPH NJ
07869-2949
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-7272
  • Fax:
Mailing address:
  • Phone: 862-432-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01305600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: