Provider Demographics
NPI:1811334063
Name:DR MARIA A CAMPOALEGRE MD.PA
Entity type:Organization
Organization Name:DR MARIA A CAMPOALEGRE MD.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPOALEGRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-249-2327
Mailing Address - Street 1:407 39TH ST
Mailing Address - Street 2:STE#403
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4817
Mailing Address - Country:US
Mailing Address - Phone:201-249-2327
Mailing Address - Fax:201-330-2838
Practice Address - Street 1:407 39TH ST
Practice Address - Street 2:STE#403
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4817
Practice Address - Country:US
Practice Address - Phone:201-249-2327
Practice Address - Fax:201-330-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08668100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0227196Medicaid
NJ176989Medicare PIN