Healthcare Provider Details

I. General information

NPI: 1972885895
Provider Name (Legal Business Name): WALTER CIFUENTES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

677 BALTUSROL WAY
BRIDGEWATER NJ
08807-1617
US

V. Phone/Fax

Practice location:
  • Phone: 908-790-0490
  • Fax: 908-790-0496
Mailing address:
  • Phone: 732-735-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02484400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: