Provider Demographics
NPI:1154481760
Name:FLORES, ALAN
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1742
Mailing Address - Country:US
Mailing Address - Phone:201-374-2201
Mailing Address - Fax:201-374-2202
Practice Address - Street 1:155 N WASHINGTON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1742
Practice Address - Country:US
Practice Address - Phone:201-374-2201
Practice Address - Fax:201-374-2202
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01053700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
117858RB9Medicare PIN