Individual
MAGDIEL LENIN FUENTES FUNEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
350 ENGLE ST FL 5, ENGLEWOOD, NJ 07631-1808
(201) 894-3636
Mailing address
331 NEWMAN SPRINGS RD STE 220, RED BANK, NJ 07701-5792
(732) 807-0877
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00577200
NJ
363AM0700X
Medical Physician Assistant
PA54487
CA
363AS0400X
Surgical Physician Assistant
25MP00577200
NJ
363AS0400X
Surgical Physician Assistant
3083
SC
363AS0400X
Surgical Physician Assistant
PA54487
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0977721
—
NJ
Enumeration date
06/20/2017
Last updated
01/03/2025
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