MEDICARE: DR. MICHAEL AUGUST DEGENNARO 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	MA43770	NJ

General Provider Information

NPI Number	:	1598713786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL AUGUST DEGENNARO M.D.

Provider Business Mailing Address
First Line	:	161A N WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1739
Country	:	US
Telephone Number	:	201-387-6900
Fax Number	:	201-387-1650

Provider Business Practice Location Address
First Line	:	161A N WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1739
Country	:	US
Telephone Number	:	201-387-6900
Fax Number	:	201-387-1650

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/14/2010

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