Healthcare Provider Details

I. General information

NPI: 1326356833
Provider Name (Legal Business Name): NICHOLAS T PECORELLI M D L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 HACKENSACK ST
WOOD RIDGE NJ
07075-1206
US

IV. Provider business mailing address

277 HACKENSACK ST
WOOD RIDGE NJ
07075-1206
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-5500
  • Fax: 201-438-3363
Mailing address:
  • Phone: 201-438-5500
  • Fax: 201-438-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06462500
License Number StateNJ

VIII. Authorized Official

Name: NICHOLAS T PECORELLI
Title or Position: MEMBER
Credential: M.D.
Phone: 201-438-5500