Provider Demographics
NPI:1245239490
Name:SKARIMBAS, ALICIA C (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:SKARIMBAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 GRAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4109
Mailing Address - Country:US
Mailing Address - Phone:201-567-3370
Mailing Address - Fax:201-816-1265
Practice Address - Street 1:370 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4154
Practice Address - Country:US
Practice Address - Phone:201-567-3370
Practice Address - Fax:201-816-1265
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07489600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3269OtherMVP
MA710555OtherHARVARD PILGRIM HEALTH CA
NY02632415Medicaid
MA000000028988Medicaid
MA34828OtherHEALTH NEW ENGLAND
MAJ27848OtherBLUE CROSS
MA2081491Medicaid
MAI10324Medicare UPIN
MAA37195Medicare ID - Type Unspecified