Healthcare Provider Details

I. General information

NPI: 1275300444
Provider Name (Legal Business Name): JUAN R ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CHARNWOOD DR
WYCKOFF NJ
07481-1013
US

IV. Provider business mailing address

812 CHARNWOOD DR
WYCKOFF NJ
07481-1013
US

V. Phone/Fax

Practice location:
  • Phone: 201-290-9540
  • Fax: 201-290-9540
Mailing address:
  • Phone: 201-290-9540
  • Fax: 201-290-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: