Provider Demographics
NPI:1972788859
Name:JOSEPH PETER FODERO MD PA
Entity Type:Organization
Organization Name:JOSEPH PETER FODERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FODERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-295-6565
Mailing Address - Street 1:220 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1348
Mailing Address - Country:US
Mailing Address - Phone:973-295-6565
Mailing Address - Fax:973-295-6567
Practice Address - Street 1:220 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1348
Practice Address - Country:US
Practice Address - Phone:973-295-6565
Practice Address - Fax:973-295-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06938000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ120083Medicare PIN