Provider Demographics
NPI:1770987885
Name:MARIE EMMA B. ALVAREZ MD LLC
Entity type:Organization
Organization Name:MARIE EMMA B. ALVAREZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-225-9852
Mailing Address - Street 1:1455 MAIN AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2127
Mailing Address - Country:US
Mailing Address - Phone:862-225-9852
Mailing Address - Fax:862-225-9853
Practice Address - Street 1:1455 MAIN AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2127
Practice Address - Country:US
Practice Address - Phone:862-225-9852
Practice Address - Fax:862-225-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08158100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0324060Medicaid