MEDICARE: MS. JENNIFER ANNE PEZZATTI

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	174400000X	Specialist

General Provider Information

NPI Number	:	1114110731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANNE PEZZATTI

Provider Business Mailing Address
First Line	:	101 ARMOUR ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-2403
Country	:	US
Telephone Number	:	508-916-0526
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 ARMOUR ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-2403
Country	:	US
Telephone Number	:	508-916-0526
Fax Number	:

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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