Provider Demographics
NPI:1952414849
Name:NARVAEZ, NORMITA LANDAS (MD)
Entity Type:Individual
Prefix:
First Name:NORMITA
Middle Name:LANDAS
Last Name:NARVAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NORMITA
Other - Middle Name:G
Other - Last Name:LANDAS-NARVAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:135 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5902
Mailing Address - Country:US
Mailing Address - Phone:973-743-3556
Mailing Address - Fax:973-743-3895
Practice Address - Street 1:135 BLOOMFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5902
Practice Address - Country:US
Practice Address - Phone:973-743-3556
Practice Address - Fax:973-743-3895
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO50477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3969304Medicaid
NJNA 1990088Medicare ID - Type Unspecified
NJE13256Medicare UPIN