Provider Demographics
NPI:1427025956
Name:DORNEO, AURORA BALADAD (MD)
Entity Type:Individual
Prefix:
First Name:AURORA
Middle Name:BALADAD
Last Name:DORNEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2916
Mailing Address - Country:US
Mailing Address - Phone:201-823-0313
Mailing Address - Fax:201-823-0979
Practice Address - Street 1:850 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2916
Practice Address - Country:US
Practice Address - Phone:201-823-0313
Practice Address - Fax:201-823-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62573208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0050211Medicaid