=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467446435
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HASMIK DIRATZOUIAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 RIVERVIEW PLZ
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-530-2468
-----------------------------------------------------
Fax | 732-345-2010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 RIVERVIEW PLZ
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-530-2468
-----------------------------------------------------
Fax | 732-345-2010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 25MA07907700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------