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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X25MB03694500NJY Other Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
438390301NJAETNA PPO ID #OTHER
03T18101NJEMPIRE BC/BS OF NY ID #OTHER
20003992201NJRR MDCR#OTHER
56813701NJAETNA HMO ID #OTHER
BS47301NJOXFORD ID #OTHER


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