Provider Demographics
NPI:1881641827
Name:PIERETTI, GORDON ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ANTHONY
Last Name:PIERETTI
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 1:3806 BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-3208
Mailing Address - Country:US
Mailing Address - Phone:609-898-7447
Mailing Address - Fax:609-898-1912
Practice Address - Street 1:3806 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3208
Practice Address - Country:US
Practice Address - Phone:609-898-7447
Practice Address - Fax:609-898-1912
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07195700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN
053688SK3Medicare PIN