Healthcare Provider Details

I. General information

NPI: 1518938422
Provider Name (Legal Business Name): IGOR PRIVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ROUTE 9 STE 8
MANALAPAN NJ
07726
US

IV. Provider business mailing address

345 ROUTE 9 STE 8
MANALAPAN NJ
07726-3240
US

V. Phone/Fax

Practice location:
  • Phone: 732-845-2200
  • Fax: 732-845-0154
Mailing address:
  • Phone: 732-845-2200
  • Fax: 732-845-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA07691500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: