MEDICARE: DR. PAUL WILLIAM PROSPERI D.O.

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	207Q00000X	Family Medicine Physician	25MB06900900	NJ

General Provider Information

NPI Number	:	1952416588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL WILLIAM PROSPERI D.O.

Provider Business Mailing Address
First Line	:	1812 LONG BEACH BLVD
Second Line	:
City	:	SHIP BOTTOM
State	:	NJ
Zip	:	08008-4443
Country	:	US
Telephone Number	:	609-494-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 LONG BEACH BLVD
Second Line	:
City	:	SHIP BOTTOM
State	:	NJ
Zip	:	08008-4443
Country	:	US
Telephone Number	:	609-494-2323
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/05/2011

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