Provider Demographics
NPI:1164506176
Name:PILLA, DAVID M (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PILLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1562
Mailing Address - Country:US
Mailing Address - Phone:856-667-1856
Mailing Address - Fax:856-667-1856
Practice Address - Street 1:3020 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1562
Practice Address - Country:US
Practice Address - Phone:856-667-1856
Practice Address - Fax:856-667-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00194900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1530003Medicaid
NJ1530003Medicaid
NJ676568Medicare ID - Type Unspecified