Healthcare Provider Details

I. General information

NPI: 1528978152
Provider Name (Legal Business Name): JUAN CARLOS TLAPALA CLEMENTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAPLE AVE
CHESTER NJ
07930-2521
US

IV. Provider business mailing address

135 MAPLE AVE
CHESTER NJ
07930-2521
US

V. Phone/Fax

Practice location:
  • Phone: 973-668-0858
  • Fax:
Mailing address:
  • Phone: 973-668-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: