Healthcare Provider Details

I. General information

NPI: 1659443364
Provider Name (Legal Business Name): TWO RIVER ALLERGY & ASTHMA GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NORTH GILBERT STREET SUITE 1201 BLDG #1 SECOND FLOOR
TINTON FALLS NJ
07701-4960
US

IV. Provider business mailing address

55 NORTH GILBERT STREET SUITE 1201 BLDG #1 SECOND FLOOR
TINTON FALLS NJ
07701-4960
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-8188
  • Fax: 732-747-5946
Mailing address:
  • Phone: 732-747-8188
  • Fax: 732-747-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK J. PICONE
Title or Position: PRESIDENT
Credential: M.D,
Phone: 732-747-8188