Healthcare Provider Details

I. General information

NPI: 1518057694
Provider Name (Legal Business Name): PAULA M. PESCI, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 SOUTH ST SUITE 201
NEW PROVIDENCE NJ
07974-1999
US

IV. Provider business mailing address

1 GLIMPSEWOOD LN
MORRISTOWN NJ
07960-3767
US

V. Phone/Fax

Practice location:
  • Phone: 973-615-9217
  • Fax: 973-292-9565
Mailing address:
  • Phone: 973-615-9217
  • Fax: 973-292-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number25MA04765200
License Number StateNJ

VIII. Authorized Official

Name: DR. PAULA MARIE PESCI
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 973-615-9217