Provider Demographics
NPI:1417022062
Name:LAT, EMMANUEL ALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ALINA
Last Name:LAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17 ARCADIAN WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1245
Mailing Address - Country:US
Mailing Address - Phone:201-843-0700
Mailing Address - Fax:201-843-0622
Practice Address - Street 1:17 ARCADIAN WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1245
Practice Address - Country:US
Practice Address - Phone:201-843-0700
Practice Address - Fax:201-843-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03883200208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLA446398Medicare UPIN