Tina M Petillo, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

44503 Issued in NJ

Practice address

340 East Northfield Road
Suite 2E
Livingston, NJ 07039-4892

Phone

(973) 533-0001

Fax

(973) 716-0306

NPI assigned

Jul 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301443200000",
    "number": "1962437244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 E NORTHFIELD RD STE 2E",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394892",
            "telephone_number": "973-533-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 EAST NORTHFIELD ROAD",
            "address_2": "SUITE 2E",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394892",
            "telephone_number": "973-533-0001",
            "fax_number": "973-716-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETILLO",
        "first_name": "TINA",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2011-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "44503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7413505",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David John Perna, M.D.
• Nicolette Perrone
• Sheila Faith Icamen Pesta, PT
• Penina Lisa Petchers, PSY.D.
• Lauren Rachel Petersen, L.C.S.W.
• Sylvia Jean Petrone, MD
• Deborah Petrowsky, M.D.
• Vito A Petrozzino X, M.D.
• Serena Petullo, MSW, LSW
• Merin Philips

• Obstetrics & Gynecology Physician in Livingston, NJ
• Providers in Livingston, NJ by specialty
• Obstetrics & Gynecology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.