Provider Demographics
NPI:1740405075
Name:ALFREDO FESTA M.D.P.C.
Entity Type:Organization
Organization Name:ALFREDO FESTA M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-864-3168
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07015-2475
Mailing Address - Country:US
Mailing Address - Phone:201-864-3168
Mailing Address - Fax:201-864-4488
Practice Address - Street 1:4508 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2707
Practice Address - Country:US
Practice Address - Phone:201-864-3168
Practice Address - Fax:201-864-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03916500207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3803503Medicaid
NJC55332Medicare UPIN
NJFE452515Medicare ID - Type Unspecified