Provider Demographics
NPI:1932148772
Name:PEDERSEN, IRENE A (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:A
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STATE ROUTE 31
Mailing Address - Street 2:SUITE 121
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5795
Mailing Address - Country:US
Mailing Address - Phone:908-782-2825
Mailing Address - Fax:908-782-0196
Practice Address - Street 1:111 STATE ROUTE 31
Practice Address - Street 2:SUITE 121
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5795
Practice Address - Country:US
Practice Address - Phone:908-782-2825
Practice Address - Fax:908-782-0196
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA051187207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158048BM2Medicare ID - Type Unspecified
NJC58803Medicare UPIN