Provider Demographics
NPI:1902804792
Name:TUFANKJIAN, DEARON K (DO)
Entity Type:Individual
Prefix:DR
First Name:DEARON
Middle Name:K
Last Name:TUFANKJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1200
Mailing Address - Country:US
Mailing Address - Phone:609-890-0033
Mailing Address - Fax:609-689-6067
Practice Address - Street 1:8 QUAKERBRIDGE PLZ
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1255
Practice Address - Country:US
Practice Address - Phone:609-890-0033
Practice Address - Fax:609-890-0440
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB066697002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8820805Medicaid
NJ8820805Medicaid
NJ057148Medicare ID - Type Unspecified