Provider Demographics
NPI:1851342703
Name:TEJEDA, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:TEJEDA
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 1:916-922 MAIN AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-8544
Mailing Address - Country:US
Mailing Address - Phone:973-773-0334
Mailing Address - Fax:
Practice Address - Street 1:916 MAIN AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8513
Practice Address - Country:US
Practice Address - Phone:973-773-0334
Practice Address - Fax:973-773-0336
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0171719Medicaid
NY02624995Medicaid
NYI22919Medicare UPIN
NJ134252UXWMedicare PIN
NJ0171719Medicaid
NJ0171719Medicaid