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General NPI Number Information
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NPI Number | 1871444307
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Entity Type | Individual
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Provider Name | MR. MICHAEL D'ERCOLE JR.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 140 HERBERT AVE # 2
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City | CLOSTER
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State | NJ
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Zip | 07624-1300
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Country | US
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Telephone | 201-540-6315
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Fax |
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Provider Business Mailing Address
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Address Line | 140 HERTBERT AVE #2
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City | CLOSTER
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State | NJ
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Zip | 07624
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Country | US
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Telephone | 201-540-6315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00975100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 034846-01
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License Number State | NY
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