Basic Information
| Provider Information | |||||||||
| NPI: | 1578509394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PICCONE | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9710 VENTNOR AVE | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084022223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098224800 | ||||||||
| FaxNumber: | 6098222617 | ||||||||
| Practice Location | |||||||||
| Address1: | 9710 VENTNOR AVE | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084022223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098224800 | ||||||||
| FaxNumber: | 6098222617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 25MB03332700 | NJ | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | MB033327 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 222725033 | 01 | NJ | TAX ID# | OTHER | 19826 | 01 | NJ | AMERIGROUP | OTHER |