MEDICARE: DR. ALEXANDER ESTRADA D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N005748-1	NY
2	213E00000X	Podiatrist	25MD00268900	NJ
3	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00268900	NJ
4	213ES0131X	Foot Surgery Podiatrist	N005748-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922093939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER ESTRADA D.P.M.

Provider Business Mailing Address
First Line	:	146 34TH ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5903
Country	:	US
Telephone Number	:	201-865-3400
Fax Number	:	201-766-3414

Provider Business Practice Location Address
First Line	:	5005 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5563
Country	:	US
Telephone Number	:	201-865-3400
Fax Number	:	201-520-0040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	11/01/2011

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