Healthcare Provider Details

I. General information

NPI: 1609848977
Provider Name (Legal Business Name): ANDREAS E XAGORARIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

PO BOX 18914
NEWARK NJ
07191-8914
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-0066
  • Fax: 201-488-6769
Mailing address:
  • Phone: 201-488-0066
  • Fax: 201-488-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06720900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: