Healthcare Provider Details

I. General information

NPI: 1427020742
Provider Name (Legal Business Name): PASQUALE J YACCARINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 STATE RT 94 STE 1-C
VERNON NJ
07462-3324
US

IV. Provider business mailing address

PO BOX 95000 LB#7550
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 973-823-8800
  • Fax: 973-823-8811
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03918300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: