Provider Demographics
NPI:1124033089
Name:EMMANUEL HRISO MD PA
Entity Type:Organization
Organization Name:EMMANUEL HRISO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HRISO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-436-4080
Mailing Address - Street 1:380 MOUNTAIN RD APT 1003
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-7306
Mailing Address - Country:US
Mailing Address - Phone:201-436-4080
Mailing Address - Fax:201-436-1601
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2816
Practice Address - Country:US
Practice Address - Phone:732-855-1199
Practice Address - Fax:732-855-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4521501Medicaid
NJE94319Medicare UPIN
NJ681077Medicare ID - Type Unspecified