Provider Demographics
NPI:1992875223
Name:ISABELITA CORDOBA,MDPA
Entity type:Organization
Organization Name:ISABELITA CORDOBA,MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELITA
Authorized Official - Middle Name:YNIGO
Authorized Official - Last Name:CORDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-436-8418
Mailing Address - Street 1:39 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1813
Mailing Address - Country:US
Mailing Address - Phone:908-561-1803
Mailing Address - Fax:
Practice Address - Street 1:564 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3825
Practice Address - Country:US
Practice Address - Phone:201-436-8418
Practice Address - Fax:908-561-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2907003Medicaid
NJC56156Medicare UPIN
NJ097048Medicare ID - Type UnspecifiedINCORPORATION
NJ2907003Medicaid