=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285823583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW M CAMEROTA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2007
-----------------------------------------------------
Last Update Date | 10/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 VERONICA AVE SUITE 104
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-6802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-249-0977
-----------------------------------------------------
Fax | 732-249-1860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 VERONICA AVE SUITE 104
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-6802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-249-0977
-----------------------------------------------------
Fax | 732-249-1860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANDREW M CAMEROTA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-249-0977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA060457
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------