Provider Demographics
NPI:1114488442
Name:ROJAS ZAMALLOA, JORGE ANDRE (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ANDRE
Last Name:ROJAS ZAMALLOA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 5TH AVE # 1030
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:855-674-3278
Mailing Address - Fax:212-426-6376
Practice Address - Street 1:1190 5TH AVE # 1030
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:855-674-3278
Practice Address - Fax:212-426-6376
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA12583800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program