MEDICARE: MR. GIUSEPPE PEDULLA

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	171W00000X	Contractor	0451027440	NJ

General Provider Information

NPI Number	:	1053191924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GIUSEPPE PEDULLA

Provider Business Mailing Address
First Line	:	66 W CLARK PL
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-2454
Country	:	US
Telephone Number	:	732-664-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 W CLARK PL
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-2454
Country	:	US
Telephone Number	:	732-664-1188
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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