Healthcare Provider Details

I. General information

NPI: 1538125588
Provider Name (Legal Business Name): M ARISAN ERGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE STREET STE 100
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

48 HASTINGS DR STE 100
TENAFLY NJ
07670-1206
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax: 201-541-2188
Mailing address:
  • Phone: 201-538-2411
  • Fax: 201-569-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMA70525
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1258151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: