1578340931 NPI number — TONNY ALEJANDRO HUISACAYNA ALVIS CPED

Table of content: TONNY ALEJANDRO HUISACAYNA ALVIS CPED (NPI 1578340931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578340931 NPI number — TONNY ALEJANDRO HUISACAYNA ALVIS CPED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUISACAYNA ALVIS
Provider First Name:
TONNY
Provider Middle Name:
ALEJANDRO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPED
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:
1578340931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 SHERIDAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSELLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-884-8888
Provider Business Mailing Address Fax Number:
908-862-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 E LINDEN AVE
Provider Second Line Business Practice Location Address:
UNIT 22
Provider Business Practice Location Address City Name:
LINDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-862-3121
Provider Business Practice Location Address Fax Number:
908-862-0028
Provider Enumeration Date:
09/11/2023

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: 224L00000X , with the licence number:  45PD00001300 , 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)





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