Provider Demographics
NPI:1225107576
Name:FILIPE-IZAGUIRRE, SIRIADE (DO)
Entity Type:Individual
Prefix:
First Name:SIRIADE
Middle Name:
Last Name:FILIPE-IZAGUIRRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ABEEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1303
Mailing Address - Country:US
Mailing Address - Phone:732-745-9800
Mailing Address - Fax:732-745-9107
Practice Address - Street 1:24 ABEEL ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1303
Practice Address - Country:US
Practice Address - Phone:732-745-9800
Practice Address - Fax:732-745-9107
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07306600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01152917OtherRAILROAD MEDICARE
NJ0121576Medicaid
NJP01152917OtherRAILROAD MEDICARE
NJH65080Medicare UPIN
NJ059253Medicare ID - Type Unspecified
NJ178529A02Medicare PIN