Provider Demographics
NPI:1821090663
Name:ALVARADO, MARK U (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:U
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 - 49TH STREET
Mailing Address - Street 2:SUNSET TERRACE FAMILY HEALTH CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-437-5235
Mailing Address - Fax:718-437-5239
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:SUNSET TERRACE FAMILY HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:718-437-5235
Practice Address - Fax:718-437-5239
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056689002084A0401X
NY2296712084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5314500Medicaid
NJF00150Medicare UPIN
NJ5314500Medicaid