Healthcare Provider Details

I. General information

NPI: 1225614274
Provider Name (Legal Business Name): JOSE ENRIQUE VALDOR MARIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 37TH ST
UNION CITY NJ
07087-4994
US

IV. Provider business mailing address

408 37TH ST
UNION CITY NJ
07087-4994
US

V. Phone/Fax

Practice location:
  • Phone: 201-864-4477
  • Fax: 201-869-1819
Mailing address:
  • Phone: 201-864-4477
  • Fax: 201-864-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNJDCATEMP-036966
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01150900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: