Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA07233700 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD060583L | PA |
NPI | 1083653398 |
---|---|
Provider Name | Matthew David Pepe |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Egg Harbor Township, NJ 08234-5549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0870456000 | IBC (01) | NJ |
1048991 | CIGNA (01) | |
2562902 | AETNA (01) | NJ |
H34760 | (02) |