MEDICARE: DR. JUAN ARMANDO DESUEZA M.D.

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	MA070265	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
2	P3531958	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1871683821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN ARMANDO DESUEZA M.D.

Provider Business Mailing Address
First Line	:	416 PARK AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07504-1930
Country	:	US
Telephone Number	:	973-684-8138
Fax Number	:	973-684-0032

Provider Business Practice Location Address
First Line	:	416 PARK AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07504-1930
Country	:	US
Telephone Number	:	973-684-8138
Fax Number	:	973-684-0032

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/08/2011

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