MEDICARE: NICOLE PISANO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00371100	NJ
2	363A00000X	Physician Assistant	019307	NY
3	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1467828509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE PISANO PA-C

Provider Business Mailing Address
First Line	:	719 N BEERS ST STE 1E
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-739-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 N BEERS ST STE 1E
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-739-4414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/23/2023

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Directions to “ NICOLE PISANO PA-C” Practice Location

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