Provider Demographics
NPI:1376646992
Name:CANDIDO, FRANK M (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:M
Last Name:CANDIDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-265-4050
Mailing Address - Fax:201-666-4108
Practice Address - Street 1:645 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6295
Practice Address - Country:US
Practice Address - Phone:201-265-4050
Practice Address - Fax:201-666-4108
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03399200207R00000X, 207RG0100X
NJMA33992207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1051601Medicaid
C54985Medicare UPIN
NJ1051601Medicaid