=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568361731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPICC HOME ACCESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 FRANKLIN ST
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07044-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-348-5949
-----------------------------------------------------
Fax | 973-200-9443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 FRANKLIN ST
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07044-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-348-5949
-----------------------------------------------------
Fax | 973-200-9443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MR. BERNARD FAVARATO PERUTTI
-----------------------------------------------------
Credential | AGPCNP-BC
-----------------------------------------------------
Telephone | 973-392-1419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------