Provider Demographics
NPI:1427203306
Name:PI, JUSTIN J (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:PI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2011
Mailing Address - Country:US
Mailing Address - Phone:973-877-5493
Mailing Address - Fax:973-877-2993
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2011
Practice Address - Country:US
Practice Address - Phone:973-877-5493
Practice Address - Fax:973-877-2993
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08468200207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0183512Medicaid
NJ146512Medicare UPIN
NJ0183512Medicaid
NJ146512UXKMedicare PIN
NJ146512UXLMedicare PIN
NJ146512UWWMedicare PIN
NJ146512UWYMedicare PIN