Provider Demographics
NPI:1851426795
Name:PICILLO BROS OPTICIANS INC.
Entity Type:Organization
Organization Name:PICILLO BROS OPTICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DISPENSING OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-997-0997
Mailing Address - Street 1:32 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6355
Mailing Address - Country:US
Mailing Address - Phone:201-997-0997
Mailing Address - Fax:
Practice Address - Street 1:32 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6355
Practice Address - Country:US
Practice Address - Phone:201-997-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1096156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ652880501Medicaid
NJ652880501Medicaid