MEDICARE: DR. JOHN A COLANERI 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	207Q00000X	Family Medicine Physician	MA35513	NJ

General Provider Information

NPI Number	:	1326140088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A COLANERI M.D.

Provider Business Mailing Address
First Line	:	310 HOBOKEN RD
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-1305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 HOBOKEN RD
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-1305
Country	:	US
Telephone Number	:	201-939-4036
Fax Number	:

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	05/16/2014

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