Provider Demographics
NPI:1063470920
Name:FERREIRA, JOSE LUIS SR (RT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:FERREIRA
Suffix:SR
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1739
Mailing Address - Country:US
Mailing Address - Phone:888-964-0088
Mailing Address - Fax:917-634-4797
Practice Address - Street 1:5 HAMILTON PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6801
Practice Address - Country:US
Practice Address - Phone:908-884-0616
Practice Address - Fax:908-634-4797
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092842261QR0208X
NJ626344261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064432Medicaid
NJP00083444Medicare PIN
NJ0064432Medicaid