Provider Demographics
NPI:1952361784
Name:JARAMILLO, LUIS FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:JARAMILLO
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 1:301 60TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5422
Mailing Address - Country:US
Mailing Address - Phone:201-295-3033
Mailing Address - Fax:201-295-8592
Practice Address - Street 1:301 60TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5422
Practice Address - Country:US
Practice Address - Phone:201-295-3033
Practice Address - Fax:201-295-8592
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO7560000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104540Medicaid
NJ0104540Medicaid
NJ101180Medicare PIN