Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI009476 | NJ |
Y | 213EG0000X | General Practice | 22DI009476 | NJ |
NPI | 1003076589 |
---|---|
Provider Name | Dr. Dominic Pisano |
First Address | Whiting, NJ 08759-2931 |
Second Address | Whiting, NJ 08759-2931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 16/03/2016 |