Healthcare Provider Details

I. General information

NPI: 1861840456
Provider Name (Legal Business Name): MATTHEW PHILIP PEPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL MEB 342
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

1 ROBERT WOOD JOHNSON PL MEB 342
NEW BRUNSWICK NJ
08901-1928
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7893
  • Fax: 732-235-9340
Mailing address:
  • Phone: 732-235-7893
  • Fax: 732-235-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09885600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: