Individual
DR. SEVERIANO FAJARDO SANJUAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2040 MILLBURN AVE, SUITE 302, MAPLEWOOD, NJ 07040-3726
(973) 762-0035
(973) 762-0402
Mailing address
2040 MILLBURN AVE, SUITE 302, MAPLEWOOD, NJ 07040-3726
(973) 762-0035
(973) 762-0402
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MA34053
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1755901
—
NJ
Enumeration date
08/01/2006
Last updated
12/12/2014
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