Provider Demographics
NPI:1093071276
Name:JOSEPH PETER FODERO MD PA
Entity Type:Organization
Organization Name:JOSEPH PETER FODERO MD PA
Other - Org Name:NORTHEASTERN PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIGNORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-295-6565
Mailing Address - Street 1:83 HANOVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1508
Mailing Address - Country:US
Mailing Address - Phone:973-295-6565
Mailing Address - Fax:973-295-6567
Practice Address - Street 1:83 HANOVER RD STE 200
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1508
Practice Address - Country:US
Practice Address - Phone:973-295-6565
Practice Address - Fax:973-295-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty