Provider Demographics
NPI:1114970068
Name:ESTRADA, ARISTIDES M (MD)
Entity Type:Individual
Prefix:DR
First Name:ARISTIDES
Middle Name:M
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ROUTE #46
Mailing Address - Street 2:STE #102
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3164
Mailing Address - Country:US
Mailing Address - Phone:973-366-6060
Mailing Address - Fax:973-366-1423
Practice Address - Street 1:195 ROUTE #46
Practice Address - Street 2:STE #102
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3164
Practice Address - Country:US
Practice Address - Phone:973-366-6060
Practice Address - Fax:973-366-1423
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ31914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAE47322Medicare ID - Type Unspecified
C52765Medicare UPIN