Provider Demographics
NPI:1467479147
Name:CENTENO, LIGAYA VICTORIA (MDFACAAI)
Entity Type:Individual
Prefix:DR
First Name:LIGAYA
Middle Name:VICTORIA
Last Name:CENTENO
Suffix:
Gender:F
Credentials:MDFACAAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 DIXIE LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-2018
Mailing Address - Country:US
Mailing Address - Phone:908-757-7759
Mailing Address - Fax:732-906-1781
Practice Address - Street 1:1740 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2847
Practice Address - Country:US
Practice Address - Phone:732-321-1920
Practice Address - Fax:732-906-1781
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05764400207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6230504Medicaid
NJ402040RDSMedicare ID - Type Unspecified
NJ6230504Medicaid