Individual
IVAN BILBAO-LAVIEJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
113 W ESSEX ST, STE 201, MAYWOOD, NJ 07607-1023
(201) 251-7725
Mailing address
331 NEWMAN SPRINGS RD, BLDG 2, STE 220, RED BANK, NJ 07701-5688
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00179900
NJ
363AS0400X
Surgical Physician Assistant
009941
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00403304
RAILROAD
NY
Enumeration date
06/07/2006
Last updated
12/11/2024
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