Provider Demographics
NPI:1780743138
Name:JOHN D.PILLA MD PA
Entity type:Organization
Organization Name:JOHN D.PILLA MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-968-8900
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-2619
Mailing Address - Country:US
Mailing Address - Phone:732-968-1217
Mailing Address - Fax:732-968-4898
Practice Address - Street 1:1005 N. WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2619
Practice Address - Country:US
Practice Address - Phone:732-968-1217
Practice Address - Fax:732-968-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082028Medicare PIN