MEDICARE: DR. JOSEPH J PECORA III DO

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	207R00000X	Internal Medicine Physician	MB070954	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00028716	OTHER	NJ	PALMETTO RAILROAD MEDICARE

General Provider Information

NPI Number	:	1841204666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH J PECORA III DO

Provider Business Mailing Address
First Line	:	9 DUTCHTOWN HARLINGEN ROAD
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502
Country	:	US
Telephone Number	:	908-874-8883
Fax Number	:	908-874-3595

Provider Business Practice Location Address
First Line	:	9 DUTCHTOWN HARLINGEN ROAD
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-5115
Country	:	US
Telephone Number	:	908-874-8883
Fax Number	:	908-874-3595

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	05/22/2008

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