Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22DI02289200 | NJ |
NPI | 1063581734 |
---|---|
Provider Name | Dr. Matthew James Peluso |
First Address | Cedar Grove, NJ 07009-1802 |
Second Address | Cedar Grove, NJ 07009-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |