MEDICARE: DR. JEROME PUMO JR. D.O.,FACOFP

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	207QS0010X	Sports Medicine (Family Medicine) Physician	25MB02746100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UP094	OTHER	NJ	OXFORD
2	2237789	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1558363382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME PUMO JR. D.O.,FACOFP

Provider Business Mailing Address
First Line	:	144 KLINE BLVD
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-1925
Country	:	US
Telephone Number	:	732-574-1777
Fax Number	:	732-574-2707

Provider Business Practice Location Address
First Line	:	132 WESTFIELD AVE
Second Line	:	UNIT 1
City	:	CLARK
State	:	NJ
Zip	:	07066-2453
Country	:	US
Telephone Number	:	732-574-1777
Fax Number	:	732-574-2707

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/26/2014

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Directions to “ DR. JEROME PUMO JR. D.O.,FACOFP” Practice Location

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