Provider Demographics
NPI:1801909247
Name:ENRIQUEZ, JOSEPH E (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:ENRIQUEZ
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 1:3269 N STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3619
Mailing Address - Country:US
Mailing Address - Phone:928-757-2101
Mailing Address - Fax:
Practice Address - Street 1:416 BELLEVUE AVE
Practice Address - Street 2:STE. 104
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4513
Practice Address - Country:US
Practice Address - Phone:609-396-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60625207L00000X
NJ05198600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3620301Medicaid
NJ620134Medicare PIN
NJ3620301Medicaid