Provider Demographics
NPI:1659301117
Name:PEPE, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PEPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:468 PARISH DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4671
Mailing Address - Country:US
Mailing Address - Phone:973-686-2777
Mailing Address - Fax:973-686-2780
Practice Address - Street 1:468 PARISH DR
Practice Address - Street 2:SUITE 6
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4671
Practice Address - Country:US
Practice Address - Phone:973-785-2440
Practice Address - Fax:973-785-0141
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA29274207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ924006Medicare ID - Type Unspecified