Provider Demographics
NPI:1861406746
Name:ARTINIAN, AGOP (MD)
Entity type:Individual
Prefix:
First Name:AGOP
Middle Name:
Last Name:ARTINIAN
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 1:477 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2803
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:201-967-8443
Practice Address - Street 1:477 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657
Practice Address - Country:US
Practice Address - Phone:201-967-8425
Practice Address - Fax:201-967-8443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ951524Medicare PIN
NJF89604Medicare UPIN