Healthcare Provider Details

I. General information

NPI: 1235323460
Provider Name (Legal Business Name): ROBERT PICCIANO, M.D. & MARIA VIEIRA PICCIANO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 PACIFIC ST
NEWARK NJ
07105-1665
US

IV. Provider business mailing address

36 PACIFIC STREET
NEWARK NJ
07105
US

V. Phone/Fax

Practice location:
  • Phone: 973-578-4808
  • Fax: 973-578-2939
Mailing address:
  • Phone: 973-578-4808
  • Fax: 973-578-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05550400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA05674900
License Number StateNJ

VIII. Authorized Official

Name: MRS. FATIMA SENDAO
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-578-4808