Patricia A Piccillo, D.M.D.
Individual provider Active NPI General Practice Dentistry · Franklin, NJ
NPI 1023019783 · NPPES record last updated Mar 2, 2017
Key facts
- NPI
- 1023019783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 15803 (NJ)
- Practice address
- 190 Munsonhurst Rd
Franklin, NJ 07416-1814 - Phone
- (973) 827-3976
- Fax
- (973) 209-4518
- NPI assigned
- Aug 3, 2005
- Reactivated
- Apr 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160209000642 | NJ | Order and Referring Only - Dentist |
6204130487 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15803 | NJ | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15803 | NJ | Yes |
Addresses
Primary practice location
190 Munsonhurst Rd
Franklin, NJ 07416-1814
Mailing address
165 State Line Rd
Westtown, NY 10998-4106
Phone (845) 726-3806
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All providers in Franklin, NJ · General Practice Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.