| Carlos Sacristan, M.d., Llc | |
|
17-19 Howe Ave Passaic NJ 07055-4017 | |
| (973) 473-4399 | |
| (973) 473-4430 |
| Full Name | Carlos Sacristan, M.d., Llc |
|---|---|
| Speciality | General Practice |
| Location | 17-19 Howe Ave, Passaic, New Jersey |
| Authorized Official Name and Position | Carlos Sacristan (CEO) |
| Authorized Official Contact | 9734734399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlos Sacristan, M.d., Llc 17-19 Howe Ave Passaic NJ 07055-4017 Ph: (973) 473-4399 | Carlos Sacristan, M.d., Llc 17-19 Howe Ave Passaic NJ 07055-4017 Ph: (973) 473-4399 |
| NPI Number | 1629363627 |
|---|---|
| Provider Enumeration Date | 06/17/2011 |
| Last Update Date | 06/17/2011 |
| Medicare PECOS PAC ID | 1759569825 |
|---|---|
| Medicare Enrollment ID | O20110621000459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629363627 | NPI | - | NPPES |
| 7255306 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Carlos Sacristan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1811971229 PECOS PAC ID: 2961689419 Enrollment ID: I20110609000186 |
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