Provider Demographics
NPI:1699197202
Name:ALEJANDRO PRESILLA
Entity Type:Organization
Organization Name:ALEJANDRO PRESILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-863-8667
Mailing Address - Street 1:322 49TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5278
Mailing Address - Country:US
Mailing Address - Phone:201-863-8667
Mailing Address - Fax:201-863-0444
Practice Address - Street 1:322 49TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5278
Practice Address - Country:US
Practice Address - Phone:201-863-8667
Practice Address - Fax:201-863-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03546100302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
10664109OtherCAQH
NJ3624803Medicaid