Provider Demographics
NPI:1790234995
Name:TIRADO, CARLOS ALBERTO (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:TIRADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ARCADIAN WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1245
Mailing Address - Country:US
Mailing Address - Phone:201-977-2889
Mailing Address - Fax:201-977-2890
Practice Address - Street 1:17 ARCADIAN WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1245
Practice Address - Country:US
Practice Address - Phone:201-977-2889
Practice Address - Fax:201-977-2890
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00410900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant