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NPI Code Detail

MEDICARE: DR. EDWARD F. AVERSA

MEDICARE: DR. EDWARD F. AVERSA
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
11223G0001XGeneral Practice DentistryDIO16666NJ

General Provider Information

NPI Number : 1447340260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD F. AVERSA
Provider Business Mailing Address
First Line : 617 E PALISADE AVE
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-1831
Country : US
Telephone Number : 201-871-9292
Fax Number :
Provider Business Practice Location Address
First Line : 617 E PALISADE AVE
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-1831
Country : US
Telephone Number : 201-871-9292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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