Provider Demographics
NPI:1255657631
Name:DEMURO, PETER JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:DEMURO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1264
Mailing Address - Country:US
Mailing Address - Phone:732-370-4700
Mailing Address - Fax:
Practice Address - Street 1:100 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1264
Practice Address - Country:US
Practice Address - Phone:732-370-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB25849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine