Healthcare Provider Details

I. General information

NPI: 1235102575
Provider Name (Legal Business Name): ALEXANDER JONAS LIWAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 HWY 138 BLDG 2, SUITE 126
WALL TOWNSHIP NJ
07719-9693
US

IV. Provider business mailing address

3350 HWY 138 BLDG 2, SUITE 126
WALL TOWNSHIP NJ
07719-9693
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-6455
  • Fax: 732-280-6456
Mailing address:
  • Phone: 732-280-6455
  • Fax: 732-280-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07966900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: