Provider Demographics
NPI:1558514836
Name:TIRADO, ROBERTO (NP)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:TIRADO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 DEGRAW AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3255
Mailing Address - Country:US
Mailing Address - Phone:201-692-8812
Mailing Address - Fax:
Practice Address - Street 1:56 HAMILTON ST
Practice Address - Street 2:ST. JOSEPH OUTPATIENT CLINIC
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-2003
Practice Address - Country:US
Practice Address - Phone:973-754-4750
Practice Address - Fax:973-754-4777
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00181400163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse