Healthcare Provider Details

I. General information

NPI: 1861406746
Provider Name (Legal Business Name): AGOP ARTINIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 BERGEN BLVD
RIDGEFIELD NJ
07657
US

IV. Provider business mailing address

477 BERGEN BLVD
RIDGEFIELD NJ
07657-2803
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-8425
  • Fax: 201-967-8443
Mailing address:
  • Phone: 201-967-8425
  • Fax: 201-967-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA065552
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: