=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841339595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN EMMANUEL CADIZ HS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 CRISPIN RD MEDICAL DEPARTMENT
-----------------------------------------------------
City | HIGHLANDS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07732-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-872-3444
-----------------------------------------------------
Fax | 732-872-3454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 CRISPIN RD MEDICAL DEPARTMENT
-----------------------------------------------------
City | HIGHLANDS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07732-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-872-3444
-----------------------------------------------------
Fax | 732-872-3454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------