Healthcare Provider Details

I. General information

NPI: 1912198136
Provider Name (Legal Business Name): CHRISTOPHER DAVID PICCIOTTI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/13/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR UMDNJ SOM
STRATFORD NJ
08084-1327
US

IV. Provider business mailing address

24 VALLEYBROOK CT
BLACKWOOD NJ
08012-5447
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7050
  • Fax:
Mailing address:
  • Phone: 856-401-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08934000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: