Provider Demographics
NPI:1073612008
Name:CAMACHO, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N EVERGREEN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1862
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:856-845-9398
Practice Address - Street 1:190 N EVERGREEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1862
Practice Address - Country:US
Practice Address - Phone:844-542-2273
Practice Address - Fax:856-845-9698
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05594500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4604806Medicaid
F27371Medicare UPIN
NJ4604806Medicaid