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General NPI Number Information
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NPI Number | 1477593820
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Entity Type | Individual
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Provider Name | IVAN BILBAO-LAVIEJA PA
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 113 W ESSEX ST STE 201
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City | MAYWOOD
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State | NJ
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Zip | 07607-1023
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Country | US
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Telephone | 201-251-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD BLDG 2, STE 220
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City | RED BANK
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State | NJ
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Zip | 07701-5688
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 009941
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00179900
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License Number State | NJ
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