Provider Demographics
NPI:1285652164
Name:ARREDONDO, MARIO G (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:G
Last Name:ARREDONDO
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 1:69 CLIFFEDGE WAY
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5201
Mailing Address - Country:US
Mailing Address - Phone:908-433-5232
Mailing Address - Fax:646-448-4628
Practice Address - Street 1:69 CLIFFEDGE WAY
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5201
Practice Address - Country:US
Practice Address - Phone:908-433-5232
Practice Address - Fax:646-448-4628
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA073934002085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH09971Medicare UPIN
NJ058735Medicare PIN