MEDICARE: DR. ROBERT BECKER NEMEROFSKY 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	208200000X	Plastic Surgery Physician	25MA07215500	NJ
2	208600000X	Surgery Physician	25MA07215500	NJ

General Provider Information

NPI Number	:	1629061908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BECKER NEMEROFSKY M.D.

Provider Business Mailing Address
First Line	:	16 POCONO RD
Second Line	:	SUITE 214
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2901
Country	:	US
Telephone Number	:	973-784-1024
Fax Number	:	973-710-0887

Provider Business Practice Location Address
First Line	:	16 POCONO RD
Second Line	:	SUITE 214
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2901
Country	:	US
Telephone Number	:	973-784-1024
Fax Number	:	973-710-0887

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	02/11/2015

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