1922047166 NPI number — RODOLFO ALONSO PA

Table of content: RODOLFO ALONSO PA (NPI 1922047166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922047166 NPI number — RODOLFO ALONSO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALONSO
Provider First Name:
RODOLFO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922047166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 EASTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08901-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-545-0400
Provider Business Mailing Address Fax Number:
732-545-0465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4810 BELMAR BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-6952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-774-3880
Provider Business Practice Location Address Fax Number:
732-545-0465
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  25MP00048400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01253234 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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