Basic Information
| Provider Information | |||||||||
| NPI: | 1962402727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELTRAN | ||||||||
| FirstName: | JAVIER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23625 COMMERCE PARK | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162555700 | ||||||||
| FaxNumber: | 2162555701 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 NASSAU STREET | ||||||||
| Address2: | APT 18A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100381547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162555700 | ||||||||
| FaxNumber: | 2162555701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 185787 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0543255 | 05 | OH | MEDICAID | 10025230100 | 05 | NE | MEDICAID | 01272935 | 05 | NY | MEDICAID | 341958451012 | 01 | OH | MEDICAL MUTUAL | OTHER | P00163855 | 01 | NY | RXR MEDICARE | OTHER | 34195845111518 | 01 | TRICARE WEST | OTHER | 7713860 | 05 | SD | MEDICAID | 806974600 | 05 | ID | MEDICAID | 12749901 | 05 | AZ | MEDICAID | 735S11 | 01 | NY | BCBS | OTHER |