Provider Demographics
NPI:1083660559
Name:VAHE H HAGOPIAN MD LLC
Entity Type:Organization
Organization Name:VAHE H HAGOPIAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAGOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-723-1078
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-0706
Mailing Address - Country:US
Mailing Address - Phone:201-723-1078
Mailing Address - Fax:
Practice Address - Street 1:1117 ROUTE 46
Practice Address - Street 2:SUITE 303
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2449
Practice Address - Country:US
Practice Address - Phone:201-723-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62723207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6850600Medicaid
NJ529347Medicare ID - Type Unspecified
NJ6850600Medicaid