Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D80895 | MD |
Y | 111NI0900X | Internist | D80895 | MD |
NPI | 1003249319 |
---|---|
Provider Name | Jorge Luis Vivar-Aguirre |
First Address | Englewood, NJ 07631-1808 |
Second Address | Englewood, NJ 07631-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2013 |
Last Update Date | 07/09/2016 |