Healthcare Provider Details

I. General information

NPI: 1619191335
Provider Name (Legal Business Name): PETER JOHN NIGRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 SUMNEYTOWN PIKE
WEST POINT PA
19486
US

IV. Provider business mailing address

536 ATSION RD
SHAMONG NJ
08088-9533
US

V. Phone/Fax

Practice location:
  • Phone: 215-652-7022
  • Fax:
Mailing address:
  • Phone: 609-268-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD419200
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: