Provider Demographics
NPI:1528061975
Name:HIRAMOTO, HARLAN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:HARLAN
Middle Name:EDWARD
Last Name:HIRAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 UNION AVE
Mailing Address - Street 2:SUITE C BRIDGEWATER MEDICAL COMPLEX
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3196
Mailing Address - Country:US
Mailing Address - Phone:908-429-7600
Mailing Address - Fax:908-429-7960
Practice Address - Street 1:465 UNION AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3196
Practice Address - Country:US
Practice Address - Phone:908-429-7600
Practice Address - Fax:908-429-7960
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03970900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ651185842OtherTID
NJ4223397OtherAETNA
NJ4223397OtherAETNA
NJ074153Medicare ID - Type Unspecified
NJ074153Medicare PIN