Provider Demographics
NPI:1194109819
Name:RAMIREZ, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3223
Mailing Address - Country:US
Mailing Address - Phone:973-481-0501
Mailing Address - Fax:973-755-0767
Practice Address - Street 1:796 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3223
Practice Address - Country:US
Practice Address - Phone:734-810-5019
Practice Address - Fax:973-755-0767
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ0057410363LA2200X
NJNP#26NJ00574100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5558885Medicaid