Healthcare Provider Details

I. General information

NPI: 1255365912
Provider Name (Legal Business Name): CARLOS OSCAR DEL ALCAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 ENGLISHTOWN RD
OLD BRIDGE NJ
08857-3938
US

IV. Provider business mailing address

1810 ENGLISHTOWN RD
OLD BRIDGE NJ
08857-3938
US

V. Phone/Fax

Practice location:
  • Phone: 732-416-6900
  • Fax: 732-416-6823
Mailing address:
  • Phone: 732-416-6900
  • Fax: 732-416-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04963300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1395009
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: