Individual
JOSE OMAR MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5301 BROADWAY, WEST NEW YORK, NJ 07093-2622
(201) 866-7721
(201) 867-9183
Mailing address
5301 BROADWAY, WEST NEW YORK, NJ 07093-2622
(201) 210-0200
(201) 867-9183
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MA61477
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6509509
—
NJ
Enumeration date
06/14/2006
Last updated
03/14/2012
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