MEDICARE: PAUL KEVIN NEIDERHOFER RP

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	183500000X	Pharmacist	28RI01699200	NJ

General Provider Information

NPI Number	:	1578882338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL KEVIN NEIDERHOFER RP

Provider Business Mailing Address
First Line	:	425 S WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-4313
Country	:	US
Telephone Number	:	201-384-1147
Fax Number	:	201-384-1625

Provider Business Practice Location Address
First Line	:	425 S WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-4313
Country	:	US
Telephone Number	:	201-384-1147
Fax Number	:	201-384-1625

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

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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