Healthcare Provider Details

I. General information

NPI: 1992012157
Provider Name (Legal Business Name): PABLO A. ARTETA, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 57TH ST
WEST NEW YORK NJ
07093-2120
US

IV. Provider business mailing address

426 57TH ST
WEST NEW YORK NJ
07093-2120
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-6000
  • Fax: 201-869-6622
Mailing address:
  • Phone: 201-869-6000
  • Fax: 201-869-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number25MA5857000
License Number StateNJ

VIII. Authorized Official

Name: DR. PABLO ANIBAL ARTETA
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 201-803-0042