Provider Demographics
NPI:1265478101
Name:ALBERT-PULEO, ANTHONY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:ALBERT-PULEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2378
Mailing Address - Country:US
Mailing Address - Phone:609-654-9100
Mailing Address - Fax:609-654-8503
Practice Address - Street 1:155 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2378
Practice Address - Country:US
Practice Address - Phone:609-654-9100
Practice Address - Fax:609-654-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04498700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222933692OtherCIGNA
NJ10494OtherAETNA
NJ0113668001OtherAMERIHEALTH
NJ33894155Medicaid
NJBNP132OtherOXFORD
NJ222933692OtherUNITED HC
NJD07083Medicare UPIN
NJBNP132OtherOXFORD