Provider Demographics
NPI:1275285611
Name:PECORARO, JOHN HENRY JR (SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:PECORARO
Suffix:JR
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 OAKLAND MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8600
Mailing Address - Country:US
Mailing Address - Phone:917-405-5694
Mailing Address - Fax:
Practice Address - Street 1:80 WILLOWBROOK CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2402
Practice Address - Country:US
Practice Address - Phone:917-405-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist