Provider Demographics
NPI:1558304881
Name:DEBORJA, CANDIDO E JR (MD, FACS, PA)
Entity Type:Individual
Prefix:DR
First Name:CANDIDO
Middle Name:E
Last Name:DEBORJA
Suffix:JR
Gender:M
Credentials:MD, FACS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 JAMES ST
Mailing Address - Street 2:MEDIPLEX BUILDING, SUITE 208
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-548-9110
Mailing Address - Fax:732-494-9134
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:MEDIPLEX BUILDING, SUITE 208
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-548-9110
Practice Address - Fax:732-494-9134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ24369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist