Individual
CARLOS SACRISTAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17-19 HOWE AVE, PASSAIC, NJ 07055-4017
(973) 473-4399
(973) 473-3039
Mailing address
17-19 HOWE AVE, P.O. BOX 327, PASSAIC, NJ 07055-4017
(973) 473-4399
(973) 473-4430
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MA61947
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7255306
—
NJ
Enumeration date
11/30/2005
Last updated
12/30/2010
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