Provider Demographics
NPI:1073622783
Name:GARY V KARAKASHIAN MD PA
Entity Type:Organization
Organization Name:GARY V KARAKASHIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KARAKASHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-544-9200
Mailing Address - Street 1:107 MONMOUTH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1000
Mailing Address - Country:US
Mailing Address - Phone:732-544-9200
Mailing Address - Fax:
Practice Address - Street 1:107 MONMOUTH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1000
Practice Address - Country:US
Practice Address - Phone:732-544-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05182300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4511701Medicaid
NJ4281192OtherPROVIDER NUMBER
NJMS088OtherPROVIDER NUMBER
NJ561974Medicare ID - Type Unspecified
NJMS088OtherPROVIDER NUMBER