Active NPI
Gilberto Fuentes Jr., MD
- Pediatrics Physician
- Ridgefield Park, NJ
National Provider Identifier
1770045734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA11405200
- Practice address
- 200 Main St
Ridgefield Park, NJ 07660-1649 - Phone
- (201) 870-6099
- NPI assigned
- Apr 1, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA11405200 | NJ | Primary |
Addresses
Primary practice location
200 Main St
Ridgefield Park, NJ 07660-1649
Mailing address
1 Harmon PLZ FL 10
Secaucus, NJ 07094-2803
Phone (551) 220-4832
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA11405200 | NJ | MD | Pediatrics Physician |
Interoperability endpoints
- gfuentes77136@direct.optum.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660089600000",
"number": "1770045734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HARMON PLZ FL 10",
"city": "SECAUCUS",
"state": "NJ",
"postal_code": "070942803",
"telephone_number": "551-220-4832",
"fax_number": "551-257-7255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MAIN ST",
"city": "RIDGEFIELD PARK",
"state": "NJ",
"postal_code": "076601649",
"telephone_number": "201-870-6099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "GILBERTO",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-01",
"last_updated": "2022-08-10",
"certification_date": "2022-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA11405200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgefield Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.