Individual
DR. JORGE GUSTAVO PARDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 2ND AVE, LONG BRANCH, NJ 07740-6303
(732) 923-7700
(732) 923-7710
Mailing address
PO BOX 8000, DEPT 601, BUFFALO, NY 14267-0002
(866) 295-0041
(708) 342-2517
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA08326800
NJ
2085R0202X
Diagnostic Radiology Physician
MD049953L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014226300005
—
PA
05
—
0149420
—
NJ
05
—
0844459
—
PA
01
—
483261
PA BLUE SHIELD
PA
Enumeration date
10/07/2005
Last updated
10/14/2011
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