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General NPI Number Information
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NPI Number | 1558514836
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Entity Type | Individual
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Provider Name | ROBERTO TIRADO NP
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Gender | Male
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 56 HAMILTON ST ST. JOSEPH OUTPATIENT CLINIC
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City | PATERSON
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State | NJ
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Zip | 07505-2003
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Country | US
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Telephone | 973-754-4750
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Fax | 973-754-4777
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Provider Business Mailing Address
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Address Line | 278 DEGRAW AVE
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City | TEANECK
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State | NJ
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Zip | 07666-3255
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Country | US
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Telephone | 201-692-8812
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NJ00181400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00181400
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License Number State | NJ
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