Healthcare Provider Details

I. General information

NPI: 1750349395
Provider Name (Legal Business Name): ANISE A KACHADOURIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E 3RD AVE
ROSELLE NJ
07203-1698
US

IV. Provider business mailing address

776 E 3RD AVE
ROSELLE NJ
07203-1698
US

V. Phone/Fax

Practice location:
  • Phone: 908-259-8817
  • Fax: 908-259-8846
Mailing address:
  • Phone: 908-259-8817
  • Fax: 908-259-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA71654
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: