MEDICARE: RENEE LOPARDO-TAVERAS

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	235Z00000X	Speech-Language Pathologist	41YS00425100	NJ

General Provider Information

NPI Number	:	1104205897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE LOPARDO-TAVERAS

Provider Business Mailing Address
First Line	:	20 EDGEWOOD TER
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-2502
Country	:	US
Telephone Number	:	908-655-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 EDGEWOOD TER
Second Line	:
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-2502
Country	:	US
Telephone Number	:	908-655-5108
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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Directions to “ RENEE LOPARDO-TAVERAS ” Practice Location

Language	Start Address	Practice Location

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