Provider Demographics
NPI:1396857629
Name:DIPIERO, ALFRED M (DO)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:M
Last Name:DIPIERO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2362
Mailing Address - Country:US
Mailing Address - Phone:856-582-5678
Mailing Address - Fax:856-582-8868
Practice Address - Street 1:400 MEDICAL CENTER DR
Practice Address - Street 2:SUITE E
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2362
Practice Address - Country:US
Practice Address - Phone:856-582-5678
Practice Address - Fax:856-582-8868
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB21982207R00000X
NJMB02198200207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3374009Medicaid
NJP00396252OtherRAILROAD MEDICARE
NJ073157Medicare PIN
NJP00396252OtherRAILROAD MEDICARE