Provider Demographics
NPI:1326356833
Name:NICHOLAS T PECORELLI M D L L C
Entity Type:Organization
Organization Name:NICHOLAS T PECORELLI M D L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:PECORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-438-5500
Mailing Address - Street 1:277 HACKENSACK ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1206
Mailing Address - Country:US
Mailing Address - Phone:201-438-5500
Mailing Address - Fax:201-438-3363
Practice Address - Street 1:277 HACKENSACK ST
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-1206
Practice Address - Country:US
Practice Address - Phone:201-438-5500
Practice Address - Fax:201-438-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06462500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty