Provider Demographics
NPI:1922093939
Name:ESTRADA, ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:146 34TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5903
Mailing Address - Country:US
Mailing Address - Phone:201-865-3400
Mailing Address - Fax:201-766-3414
Practice Address - Street 1:5005 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5563
Practice Address - Country:US
Practice Address - Phone:201-865-3400
Practice Address - Fax:201-520-0040
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005748-1213E00000X, 213ES0131X
NJ25MD00268900213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056553Medicaid
NJ0056553Medicaid
NJ063918Medicare ID - Type Unspecified