MEDICARE: DR. JESUS ROBERTO ALFONSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA05064100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649266925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS ROBERTO ALFONSO MD

Provider Business Mailing Address
First Line	:	4800 PARK AVE
Second Line	:
City	:	WEEHAWKEN
State	:	NJ
Zip	:	07086-7210
Country	:	US
Telephone Number	:	201-330-8747
Fax Number	:	201-330-8947

Provider Business Practice Location Address
First Line	:	4800 PARK AVE
Second Line	:
City	:	WEEHAWKEN
State	:	NJ
Zip	:	07086-7210
Country	:	US
Telephone Number	:	201-330-8747
Fax Number	:	201-330-8947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	01/12/2017

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