Provider Demographics
NPI:1578535035
Name:DEPERIO, ALICIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:G
Last Name:DEPERIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4679 ROUTE 9 N
Mailing Address - Street 2:SUITE #8
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3384
Mailing Address - Country:US
Mailing Address - Phone:732-905-9505
Mailing Address - Fax:732-905-2448
Practice Address - Street 1:4679 ROUTE 9 N
Practice Address - Street 2:SUITE #8
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3384
Practice Address - Country:US
Practice Address - Phone:732-905-9505
Practice Address - Fax:732-905-2448
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics