Provider Demographics
NPI:1891860938
Name:ALVAREZ, ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F.
Other - Middle Name:ENRIQUE
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 FRANKLIN CORNER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAWRENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-896-1433
Mailing Address - Fax:609-896-2171
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAWRENCE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-896-1433
Practice Address - Fax:609-896-2171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03446000208600000X
NJMA34460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3616002Medicaid
NJ193620Medicare PIN
NJD84644Medicare UPIN
NJ3616002Medicaid