Provider Demographics
NPI:1144243684
Name:ARVANITIS, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:ARVANITIS
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 1:10 INDUSTRIAL WAY E
Mailing Address - Street 2:SUITE104
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3332
Mailing Address - Country:US
Mailing Address - Phone:732-389-1331
Mailing Address - Fax:732-542-8587
Practice Address - Street 1:10 INDUSTRIAL WAY E
Practice Address - Street 2:SUITE104
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3332
Practice Address - Country:US
Practice Address - Phone:732-389-1331
Practice Address - Fax:732-542-8587
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51693208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1652109Medicaid
NJ1652109Medicaid
NJ581720MPHMedicare ID - Type Unspecified