Basic Information
Provider Information | |||||||||
NPI: | 1518961887 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PICCIONE | ||||||||
FirstName: | FRANCIS | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 718 SMYTH RD | ||||||||
Address2: | VA MEDICAL CENTER 111/112 | ||||||||
City: | MANCHESTER | ||||||||
State: | NH | ||||||||
PostalCode: | 031047007 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036244366 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 718 SMYTH RD | ||||||||
Address2: | VA MEDICAL CENTER 111/112 | ||||||||
City: | MANCHESTER | ||||||||
State: | NH | ||||||||
PostalCode: | 031047007 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036244366 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/02/2005 | ||||||||
LastUpdateDate: | 09/03/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MB03694500 | NJ | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 4383903 | 01 | NJ | AETNA PPO ID # | OTHER | 03T181 | 01 | NJ | EMPIRE BC/BS OF NY ID # | OTHER | 200039922 | 01 | NJ | RR MDCR# | OTHER | 568137 | 01 | NJ | AETNA HMO ID # | OTHER | BS473 | 01 | NJ | OXFORD ID # | OTHER |