Provider Demographics
NPI:1437182581
Name:SCIVOLETTI, PETER D (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:SCIVOLETTI
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 1:760 PARAMUS RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1730
Mailing Address - Country:US
Mailing Address - Phone:201-445-1819
Mailing Address - Fax:201-445-3203
Practice Address - Street 1:760 PARAMUS RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1730
Practice Address - Country:US
Practice Address - Phone:201-445-1819
Practice Address - Fax:201-445-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC461303Medicare ID - Type Unspecified
C56276Medicare UPIN