MEDICARE: DR. ELIZABETH PINKY PAMINTUAN DE PERIO 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	25MA06079900	NJ

General Provider Information

NPI Number	:	1033138540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH PINKY PAMINTUAN DE PERIO M.D.

Provider Business Mailing Address
First Line	:	4677 US HIGHWAY 9
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3384
Country	:	US
Telephone Number	:	732-901-7786
Fax Number	:	732-901-4080

Provider Business Practice Location Address
First Line	:	4677 US HIGHWAY 9
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3384
Country	:	US
Telephone Number	:	732-901-7786
Fax Number	:	732-901-4080

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/07/2008

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