Provider Demographics
NPI:1053616565
Name:FIERRO, LUISA A (MD)
Entity type:Individual
Prefix:DR
First Name:LUISA
Middle Name:A
Last Name:FIERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LUISA
Other - Middle Name:A
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:670 N BEERS ST
Mailing Address - Street 2:BLDG#2, #STE1
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1516
Mailing Address - Country:US
Mailing Address - Phone:732-226-5552
Mailing Address - Fax:732-757-0824
Practice Address - Street 1:670 N BEERS ST
Practice Address - Street 2:BLDG#2, #STE1
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1516
Practice Address - Country:US
Practice Address - Phone:732-226-5552
Practice Address - Fax:732-757-0824
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37578207Q00000X
NJMA07263400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJZ142914OtherMEDICARE NUMBER