Provider Demographics
NPI:1962426114
Name:MIRANDA, APOLINARIO JR (MD)
Entity type:Individual
Prefix:
First Name:APOLINARIO
Middle Name:
Last Name:MIRANDA
Suffix:JR
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 1:630 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1935
Mailing Address - Country:US
Mailing Address - Phone:609-561-7548
Mailing Address - Fax:609-561-7520
Practice Address - Street 1:630 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1935
Practice Address - Country:US
Practice Address - Phone:609-561-7548
Practice Address - Fax:609-561-7520
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02224000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18524Medicare UPIN