Provider Demographics
NPI:1649425083
Name:ANDRADE, JOSE G (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:ANDRADE
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 1:157 BROAD ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2028
Mailing Address - Country:US
Mailing Address - Phone:732-530-2960
Mailing Address - Fax:
Practice Address - Street 1:157 BROAD ST
Practice Address - Street 2:SUITE 317
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2028
Practice Address - Country:US
Practice Address - Phone:732-530-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08583400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0216348Medicaid
NJ0216348Medicaid