Basic Information
Provider Information | |||||||||
NPI: | 1396857629 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DIPIERO | ||||||||
FirstName: | ALFRED | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 400 MEDICAL CENTER DR | ||||||||
Address2: | SUITE E | ||||||||
City: | SEWELL | ||||||||
State: | NJ | ||||||||
PostalCode: | 080802362 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565825678 | ||||||||
FaxNumber: | 8565828868 | ||||||||
Practice Location | |||||||||
Address1: | 400 MEDICAL CENTER DR | ||||||||
Address2: | SUITE E | ||||||||
City: | SEWELL | ||||||||
State: | NJ | ||||||||
PostalCode: | 080802362 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565825678 | ||||||||
FaxNumber: | 8565828868 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 10/30/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MB21982 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RR0500X | MB02198200 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
ID | Type | State | Issuer | Description | 3374009 | 05 | NJ |   | MEDICAID | P00396252 | 01 | NJ | RAILROAD MEDICARE | OTHER |