Provider Demographics
NPI:1326040155
Name:ORQUIZA, CLODUALDO S (MD)
Entity Type:Individual
Prefix:DR
First Name:CLODUALDO
Middle Name:S
Last Name:ORQUIZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2106 NEW RD
Mailing Address - Street 2:C9
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1046
Mailing Address - Country:US
Mailing Address - Phone:609-927-8881
Mailing Address - Fax:609-927-8832
Practice Address - Street 1:2106 NEW RD
Practice Address - Street 2:C9
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1046
Practice Address - Country:US
Practice Address - Phone:609-927-8881
Practice Address - Fax:609-927-8832
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070986207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH20469Medicare UPIN
NJ039627SD5Medicare ID - Type Unspecified