MEDICARE: EVERALDO G CLAVEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MA026814	NJ

General Provider Information

NPI Number	:	1053366583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVERALDO G CLAVEL MD

Provider Business Mailing Address
First Line	:	155 ROUTE 94
Second Line	:
City	:	BLAIRSTOWN
State	:	NJ
Zip	:	07825
Country	:	US
Telephone Number	:	908-362-8866
Fax Number	:	908-362-6984

Provider Business Practice Location Address
First Line	:	155 ROUTE 94
Second Line	:
City	:	BLAIRSTOWN
State	:	NJ
Zip	:	07825
Country	:	US
Telephone Number	:	908-362-8866
Fax Number	:	908-362-6984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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