Provider Demographics
NPI:1578509394
Name:PICCONE, DENNIS L (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:PICCONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2223
Mailing Address - Country:US
Mailing Address - Phone:609-822-4800
Mailing Address - Fax:609-822-2617
Practice Address - Street 1:9710 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:NJ
Practice Address - Zip Code:08402-2223
Practice Address - Country:US
Practice Address - Phone:609-822-4800
Practice Address - Fax:609-822-2617
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03332700208D00000X
NJMB033327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222725033OtherTAX ID#
NJ19826OtherAMERIGROUP
NJ19826OtherAMERIGROUP
NJ222725033OtherTAX ID#