MEDICARE: MR. DANIEL P PIELOCH RD

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	133V00000X	Registered Dietitian	952155	NJ

General Provider Information

NPI Number	:	1487946547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL P PIELOCH RD

Provider Business Mailing Address
First Line	:	10 PLUM ST
Second Line	:	7TH FLOOR
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1924
Country	:	US
Telephone Number	:	732-253-3340
Fax Number	:	732-253-3476

Provider Business Practice Location Address
First Line	:	10 PLUM ST
Second Line	:	7TH FLOOR
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1924
Country	:	US
Telephone Number	:	732-253-3340
Fax Number	:	732-253-3476

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

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	05/09/2011

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