Provider Demographics
NPI:1356386866
Name:JAVIER, AUGUSTO CORPUZ
Entity type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:CORPUZ
Last Name:JAVIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-549-2176
Mailing Address - Fax:732-549-1424
Practice Address - Street 1:1821 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-549-2176
Practice Address - Fax:732-549-1424
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02466900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0105916000OtherAMERIHEALTH
0105916000OtherAMERIHEALTH
NJ457076Medicare ID - Type UnspecifiedPROVIDER #