=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831213503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D PISANO & R PROCOPIO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 797 SPRINGFIELD AVE
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-273-1525
-----------------------------------------------------
Fax | 908-273-4858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 797 SPRINGFIELD AVE
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-273-1525
-----------------------------------------------------
Fax | 908-273-4858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD D PROCOPIO
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 908-273-1525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9461
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9476
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------