Individual
JOHN-ERIC VALLARTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 BAY AVENUE, MOUNTAINSIDE MEDICAL CENTER, MONTCLAIR, NJ 07042
(973) 429-6000
Mailing address
8 PINE TREE DR, WAYNE, NJ 07470-5426
(732) 236-1772
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26N011136700
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
26NJ00341600
NJ
367500000X
Certified Registered Nurse Anesthetist
5116A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000521892
BCBS
KY
05
—
7100005840
—
KY
Enumeration date
06/24/2006
Last updated
10/19/2022
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