MEDICARE: DR. ALICIA G DEPERIO 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	208000000X	Pediatrics Physician	MA44838	NJ

General Provider Information

NPI Number	:	1578535035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA G DEPERIO M.D.

Provider Business Mailing Address
First Line	:	4679 ROUTE 9 N
Second Line	:	SUITE #8
City	:	HOWELL
State	:	NJ
Zip	:	07731-3384
Country	:	US
Telephone Number	:	732-905-9505
Fax Number	:	732-905-2448

Provider Business Practice Location Address
First Line	:	4679 ROUTE 9 N
Second Line	:	SUITE #8
City	:	HOWELL
State	:	NJ
Zip	:	07731-3384
Country	:	US
Telephone Number	:	732-905-9505
Fax Number	:	732-905-2448

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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