Provider Demographics
NPI:1376660068
Name:ALMODOVAR, ASTRID TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:TERESA
Last Name:ALMODOVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASTRID
Other - Middle Name:TERESA
Other - Last Name:ALMODOVAR DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:465 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2907
Mailing Address - Country:US
Mailing Address - Phone:973-483-3640
Mailing Address - Fax:973-483-4895
Practice Address - Street 1:465 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2907
Practice Address - Country:US
Practice Address - Phone:973-483-3640
Practice Address - Fax:973-483-4895
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0569200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF18535Medicare UPIN