MEDICARE: DR. LORIE JEAN REDER M.D.

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	207R00000X	Internal Medicine Physician	MA53851	NJ

General Provider Information

NPI Number	:	1316085467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORIE JEAN REDER M.D.

Provider Business Mailing Address
First Line	:	11 CLEVELAND PL
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1507
Country	:	US
Telephone Number	:	908-598-0606
Fax Number	:	908-598-1955

Provider Business Practice Location Address
First Line	:	11 CLEVELAND PL
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1507
Country	:	US
Telephone Number	:	908-598-0606
Fax Number	:	908-598-1955

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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