Provider Demographics
NPI:1598358699
Name:ALTAMIRANO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ALTAMIRANO
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 1:206 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3384
Mailing Address - Country:US
Mailing Address - Phone:732-210-0509
Mailing Address - Fax:
Practice Address - Street 1:206 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3384
Practice Address - Country:US
Practice Address - Phone:732-210-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)