Provider Demographics
NPI:1518579705
Name:JORGE, MIGUEL H
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:H
Last Name:JORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MONROE ST STE 4-7
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5207
Mailing Address - Country:US
Mailing Address - Phone:516-884-4940
Mailing Address - Fax:
Practice Address - Street 1:303 125TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1227
Practice Address - Country:US
Practice Address - Phone:516-884-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty