Individual
TITO AVENTURADO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 GRAND ST, JERSEY CITY, NJ 07302-4321
(201) 871-6073
(201) 871-0619
Mailing address
375 ENGLE ST, SECOND FLOOR, ENGLEWOOD, NJ 07631-1823
(201) 871-6073
(201) 871-0619
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA03735600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487001
—
NJ
01
—
P00241431
RAILROAD MEDICARE
NJ
Enumeration date
06/24/2006
Last updated
07/08/2007
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