Provider Demographics
NPI:1922027820
Name:FEDELI, AMERIGO J (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMERIGO
Middle Name:J
Last Name:FEDELI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 JACKSON RD
Mailing Address - Street 2:LAUREL PROFESSIONAL CENTER - SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9231
Mailing Address - Country:US
Mailing Address - Phone:609-654-1300
Mailing Address - Fax:609-654-0040
Practice Address - Street 1:135 JACKSON RD
Practice Address - Street 2:LAUREL PROFESSIONAL CENTER - SUITE A
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9231
Practice Address - Country:US
Practice Address - Phone:609-654-1300
Practice Address - Fax:609-654-0040
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 196761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6970303Medicaid
NJ6970303Medicaid
NJU61818Medicare UPIN