MEDICARE: DR. ALICIA SUE PELLER M.D.

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	MA47707	NJ

General Provider Information

NPI Number	:	1548216617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA SUE PELLER M.D.

Provider Business Mailing Address
First Line	:	163 BURLINGTON PATH RD
Second Line	:	UNIT L
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-1622
Country	:	US
Telephone Number	:	609-758-1100
Fax Number	:	609-758-3188

Provider Business Practice Location Address
First Line	:	163 BURLINGTON PATH RD
Second Line	:	UNIT L
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-1622
Country	:	US
Telephone Number	:	609-758-1100
Fax Number	:	609-758-3188

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/17/2022

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