Active NPI
Julian Entrada, MD
- Anesthesiology Physician
- Newark, NJ
National Provider Identifier
1104823921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 25MA03175300
- Practice address
- 268 Martin Luther King Jr Blvd
Newark, NJ 07102-2011 - Phone
- (973) 877-5034
- Fax
- (973) 877-5231
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 25MA03175300 | NJ | Primary |
| Specialist | 174400000X | MA31753 | NJ |
Addresses
Primary practice location
268 Martin Luther King Jr Blvd
Newark, NJ 07102-2011
Mailing address
PO Box 1593
Secaucus, NJ 07096-1593
Phone (201) 635-1003
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0358801 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA31753 | NJ | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374451200000",
"number": "1104823921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1593",
"city": "SECAUCUS",
"state": "NJ",
"postal_code": "070961593",
"telephone_number": "201-635-1003",
"fax_number": "201-635-1332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "268 MARTIN LUTHER KING JR BLVD",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071022011",
"telephone_number": "973-877-5034",
"fax_number": "973-877-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENTRADA",
"first_name": "JULIAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2013-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NJ",
"license": "25MA03175300",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NJ",
"license": "MA31753",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0358801",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.