MEDICARE: DR. ALFONSO CIERVO MD

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	25MA06756800	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00158098	OTHER	NJ	RAILROAD MEDICARE ID #

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
2	2K7795	OTHER	NJ	HEALTHNET ID #
3	5337R1	OTHER	NJ	BCBS OF NY ID #
4	2313631000	OTHER	NJ	AMERIHEALTH ID #
5	7790588	OTHER	NJ	AETNA PPO ID #
6	8221858	OTHER	NJ	GHI PPO ID #
7	3732796	OTHER	NJ	AETNA HMO ID #
8	97662	OTHER	NJ	AMERICAID / AMERIGROUP #

General Provider Information

NPI Number	:	1457346918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFONSO CIERVO MD

Provider Business Mailing Address
First Line	:	4 CRAPE MYRTLE DR
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1529
Country	:	US
Telephone Number	:	732-380-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 HIGHWAY 35
Second Line	:	SUITE 106A
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-3427
Country	:	US
Telephone Number	:	732-380-1222
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	09/13/2007

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