Provider Demographics
NPI:1265464473
Name:FEDERICI, PETER JAMES (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
Last Name:FEDERICI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 E CHESTNUT AVENUE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8466
Mailing Address - Country:US
Mailing Address - Phone:856-691-3273
Mailing Address - Fax:856-691-4649
Practice Address - Street 1:2815 E CHESTNUT AVENUE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8466
Practice Address - Country:US
Practice Address - Phone:856-691-3273
Practice Address - Fax:856-691-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03808900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2501601Medicaid
C52743Medicare UPIN
NJ2501601Medicaid