Provider Demographics
NPI:1285823583
Name:ANDREW M CAMEROTA MD PA
Entity Type:Organization
Organization Name:ANDREW M CAMEROTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-249-0977
Mailing Address - Street 1:49 VERONICA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6802
Mailing Address - Country:US
Mailing Address - Phone:732-249-0977
Mailing Address - Fax:732-249-1860
Practice Address - Street 1:49 VERONICA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6802
Practice Address - Country:US
Practice Address - Phone:732-249-0977
Practice Address - Fax:732-249-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6160107Medicaid
NJ6160107Medicaid
NJ1C083909Medicare PIN