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Individual

MR. VOLTAIRE REYES BALDERRAMA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
600 S LIVINGSTON AVE STE 210, LIVINGSTON, NJ 07039-5415
(800) 530-3247
Mailing address
15 FAIRVIEW AVE APT 1-A, SOUTH ORANGE, NJ 07079-2532

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PT40QA00844300
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
40QA00844300
PT LICENSE NUMBER
NJ
Enumeration date
06/13/2007
Last updated
07/08/2007
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