Provider Demographics
NPI:1912669359
Name:ESQUITE HERNANDEZ, ALAN E (CPRS-50123)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:ESQUITE HERNANDEZ
Suffix:
Gender:M
Credentials:CPRS-50123
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-1611
Mailing Address - Country:US
Mailing Address - Phone:609-840-2253
Mailing Address - Fax:
Practice Address - Street 1:213 FULTON ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1611
Practice Address - Country:US
Practice Address - Phone:609-840-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCPRS-50123175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty