Provider Demographics
NPI:1336761642
Name:HIDALGO, MIGDONIA (RPH, LAC, MSOM)
Entity Type:Individual
Prefix:
First Name:MIGDONIA
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:RPH, LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-19 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2329
Mailing Address - Country:US
Mailing Address - Phone:201-651-9100
Mailing Address - Fax:
Practice Address - Street 1:65 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1017
Practice Address - Country:US
Practice Address - Phone:201-313-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00023200171100000X
NJ28RI02162100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171100000XOther Service ProvidersAcupuncturist