Healthcare Provider Details

I. General information

NPI: 1932103355
Provider Name (Legal Business Name): ARKADIY SHRAYTMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 PARISH DR SUITE 1
WAYNE NJ
07470-4671
US

IV. Provider business mailing address

468 PARISH DR SUITE 1
WAYNE NJ
07470-4671
US

V. Phone/Fax

Practice location:
  • Phone: 973-305-8300
  • Fax: 973-305-8157
Mailing address:
  • Phone: 973-305-8300
  • Fax: 973-305-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB07640900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: