Provider Demographics
NPI:1063470920
Name:FERREIRA, JOSE LUIS SR (RT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:FERREIRA
Suffix:SR
Gender:M
Credentials:RT
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 2092
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-2092
Mailing Address - Country:US
Mailing Address - Phone:888-964-0088
Mailing Address - Fax:866-498-0867
Practice Address - Street 1:18 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1708
Practice Address - Country:US
Practice Address - Phone:908-623-0121
Practice Address - Fax:866-498-0867
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6263442471C3402X
NY0928422471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064432Medicaid
NJP00083444Medicare PIN
NJ0064432Medicaid