Provider Demographics
NPI:1932180924
Name:ESQUIERES, RAYMOND EDEL (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:EDEL
Last Name:ESQUIERES
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 1:457 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7776
Mailing Address - Country:US
Mailing Address - Phone:732-840-7500
Mailing Address - Fax:732-840-2088
Practice Address - Street 1:457 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7776
Practice Address - Country:US
Practice Address - Phone:732-840-7500
Practice Address - Fax:732-840-2088
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075366002081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I19152Medicare UPIN
084221M09Medicare ID - Type Unspecified