Provider Demographics
NPI:1740500370
Name:PIERINELLI, EUGENE P (PH)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:P
Last Name:PIERINELLI
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07524-1902
Mailing Address - Country:US
Mailing Address - Phone:973-279-0200
Mailing Address - Fax:973-279-7200
Practice Address - Street 1:418 RIVER ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07524-1902
Practice Address - Country:US
Practice Address - Phone:973-279-0200
Practice Address - Fax:973-279-7200
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01700500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0254525Medicaid
6493890001Medicare NSC