MEDICARE: DR. VERONICA CONCEPCION CODOYANNIS 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	208000000X	Pediatrics Physician	25MA03554600	NJ

General Provider Information

NPI Number	:	1497070775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERONICA CONCEPCION CODOYANNIS MD

Provider Business Mailing Address
First Line	:	13 GLENNON FARM LANE
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833
Country	:	US
Telephone Number	:	908-832-5095
Fax Number	:	908-832-7034

Provider Business Practice Location Address
First Line	:	13 GLENNON FARM LN
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-4504
Country	:	US
Telephone Number	:	908-832-5095
Fax Number	:	908-832-7034

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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