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General NPI Number Information
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NPI Number | 1730403098
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Entity Type | Organization
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Legal Business Name | MARC EGAZARIAN MD LLC
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 477 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2803
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Country | US
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Telephone | 201-941-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 477 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2803
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Country | US
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Telephone | 201-941-6999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC EGAZARIAN
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Credential | MD
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Telephone | 201-941-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MA64829
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License Number State | NJ
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