Provider Demographics
NPI:1487670865
Name:BEVACQUA, ALEJANDRO (MD PHYSICIAN)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:BEVACQUA
Suffix:
Gender:M
Credentials:MD PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTH WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2125
Mailing Address - Country:US
Mailing Address - Phone:201-384-7333
Mailing Address - Fax:201-384-2564
Practice Address - Street 1:1 NORTH WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2125
Practice Address - Country:US
Practice Address - Phone:201-384-7333
Practice Address - Fax:201-384-2564
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06768400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
579818Medicare ID - Type UnspecifiedGRP# EMPIRE MEDICRE SVRCS
G85848Medicare UPIN
NJ023099Medicare ID - Type Unspecified