Healthcare Provider Details

I. General information

NPI: 1427913722
Provider Name (Legal Business Name): ANDREW JOHN TASHJIAN MD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 BOGERT RD
RIVER EDGE NJ
07661-1844
US

IV. Provider business mailing address

391 BOGERT RD
RIVER EDGE NJ
07661-1844
US

V. Phone/Fax

Practice location:
  • Phone: 718-768-5100
  • Fax:
Mailing address:
  • Phone: 718-768-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA01797300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: