Provider Demographics
NPI:1043355381
Name:ALBORNOZ, LOUISE ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ASHLEY
Last Name:ALBORNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:US
Mailing Address - Phone:973-778-6611
Mailing Address - Fax:973-473-8434
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-778-6611
Practice Address - Fax:973-473-8434
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04993100207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4092614OtherAETNA
F03036OtherHEALTH NET
P466820OtherOXFORD
NJ3397505Medicaid
6661543OtherCIGNA
492612OtherAETNA
492612OtherAETNA
NJAL540699Medicare ID - Type Unspecified