Provider Demographics
NPI:1215971783
Name:SANCHEZ, MAURICIO JORGE (MD)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:JORGE
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3244
Mailing Address - Country:US
Mailing Address - Phone:201-991-1129
Mailing Address - Fax:201-991-2799
Practice Address - Street 1:845 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3244
Practice Address - Country:US
Practice Address - Phone:201-991-1129
Practice Address - Fax:201-991-2799
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63344207P00000X
NJ25MA06334400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7156600Medicaid
NJ7156600Medicaid
G38350Medicare UPIN