Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 26NJ00900000 | NJ |
NPI | 1033674023 |
---|---|
Provider Name | Mr. Miguel Orlando Pedraja |
First Address | Newark, NJ 07103-3841 |
Second Address | Newark, NJ 07103-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |