Provider Demographics
NPI:1841210861
Name:PICCIANO, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:PICCIANO
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 1:36 PACIFIC ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1665
Mailing Address - Country:US
Mailing Address - Phone:973-377-2974
Mailing Address - Fax:
Practice Address - Street 1:36 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1665
Practice Address - Country:US
Practice Address - Phone:973-578-4808
Practice Address - Fax:973-578-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4621506Medicaid
NJ894057Medicare ID - Type UnspecifiedGROUP #
NJ661916Medicare ID - Type Unspecified
NJE77285Medicare UPIN