Provider Demographics
NPI:1053331579
Name:ARTETA, PABLO ANIBAL (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:ANIBAL
Last Name:ARTETA
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 1:426 57TH STREET
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-869-6000
Mailing Address - Fax:201-869-6622
Practice Address - Street 1:426 57TH STREET
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-869-6000
Practice Address - Fax:201-869-6622
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05857000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7793006Medicaid
NJ027200Medicare ID - Type Unspecified
NJ7793006Medicaid