Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA04109100 | NJ |
NPI | 1275505844 |
---|---|
Provider Name | Dr. Ricardo Jp Ferraz |
First Address | Newark, NJ 07105-2495 |
Second Address | Newark, NJ 07105-2495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 24/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058663 | AMERICAN BOARD OF PEDIATR (01) | NJ |
25MA04019100 | NJ LICENSE (01) | NJ |
312-221-5 | ECFMG NUMBER (01) | NJ |
3127800 | (05) | NJ |
31D0108131 | CLIA NUMBER (01) | NJ |
AF1525243 | DEA NUMBER (01) | NJ |
C56312 | (02) | NJ |
D03302700 | NJ CDS NUMBER (01) | NJ |