MEDICARE: DR. MARY JO PARADISO 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	207RI0200X	Infectious Disease Physician	MA056530	NJ

General Provider Information

NPI Number	:	1033292867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JO PARADISO M.D

Provider Business Mailing Address
First Line	:	113 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3946
Country	:	US
Telephone Number	:	732-906-1900
Fax Number	:	732-906-6666

Provider Business Practice Location Address
First Line	:	113 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3946
Country	:	US
Telephone Number	:	732-906-1900
Fax Number	:	732-906-6666

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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