Active NPI
Peter Fiasca, PHD
- Psychologist
- JB MDL, NJ
National Provider Identifier
1073756599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS007470L
- Practice address
- 87TH Medical Group
3458 Neely Road
JB MDL, NJ 08641-5312 - Phone
- (609) 754-9324
- NPI assigned
- Apr 14, 2009
- Last updated
- Jun 12, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS007470L | PA | Primary |
Addresses
Primary practice location
87TH Medical Group
3458 Neely Road
JB MDL, NJ 08641-5312
Mailing address
3458 Neely Rd
JB MDL, NJ 08641-5312
Phone (609) 754-9324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS007470L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528761600000",
"number": "1073756599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3458 NEELY RD",
"city": "JB MDL",
"state": "NJ",
"postal_code": "086415312",
"telephone_number": "609-754-9324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87TH MEDICAL GROUP",
"address_2": "3458 NEELY ROAD",
"city": "JB MDL",
"state": "NJ",
"postal_code": "086415312",
"telephone_number": "609-754-9324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIASCA",
"first_name": "PETER",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-14",
"last_updated": "2018-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS007470L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in JB MDL, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.