Provider Demographics
NPI:1639124456
Name:PIROLLI, JOHN A (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:PIROLLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08350-0310
Mailing Address - Country:US
Mailing Address - Phone:856-697-0300
Mailing Address - Fax:856-697-8944
Practice Address - Street 1:761 S HARDING HWY
Practice Address - Street 2:
Practice Address - City:BUENA
Practice Address - State:NJ
Practice Address - Zip Code:08310-9732
Practice Address - Country:US
Practice Address - Phone:856-697-0111
Practice Address - Fax:856-697-0003
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB40881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1436104Medicaid
NJ1639124456OtherMEDICARE NPI
NJ1449977B75Medicare PIN
NJE06205Medicare UPIN