Provider Demographics
NPI:1205808300
Name:FLORES, JOSE C (DO)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:C
Last Name:FLORES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SHERMAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1529
Mailing Address - Country:US
Mailing Address - Phone:973-743-2321
Mailing Address - Fax:
Practice Address - Street 1:230 SHERMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1529
Practice Address - Country:US
Practice Address - Phone:973-743-2321
Practice Address - Fax:973-259-0600
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05438000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF42443Medicare UPIN
NJ184253AUKMedicare ID - Type Unspecified