Healthcare Provider Details

I. General information

NPI: 1083660559
Provider Name (Legal Business Name): VAHE H HAGOPIAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 ROUTE 46 SUITE 303
CLIFTON NJ
07013-2449
US

IV. Provider business mailing address

PO BOX 706
ORADELL NJ
07649-0706
US

V. Phone/Fax

Practice location:
  • Phone: 201-723-1078
  • Fax:
Mailing address:
  • Phone: 201-723-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMA62723
License Number StateNJ

VIII. Authorized Official

Name: DR. VAHE H HAGOPIAN
Title or Position: OWNER
Credential: MD
Phone: 201-723-1078