MEDICARE: PEMBERTON M.D P.C

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437686219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEMBERTON M.D P.C

Provider Business Mailing Address
First Line	:	500 ORANGE ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2944
Country	:	US
Telephone Number	:	973-844-3188
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 ORANGE ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2944
Country	:	US
Telephone Number	:	973-844-3188
Fax Number	:

Authorized Official
Title or Position	:	/OWNER
Name	:	COLIN A PEMBERTON
Credential	:	M.D
Telephone Number	:	973-844-3188

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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