Provider Demographics
NPI:1326057654
Name:HAGOPIAN, MARK LEO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEO
Last Name:HAGOPIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 ANDERSON AVE
Mailing Address - Street 2:SUITE -F
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1772
Mailing Address - Country:US
Mailing Address - Phone:201-224-6361
Mailing Address - Fax:
Practice Address - Street 1:1331 ANDERSON AVE
Practice Address - Street 2:SUITE -F
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1772
Practice Address - Country:US
Practice Address - Phone:201-224-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450908Medicare ID - Type UnspecifiedPROVIDER NUMBER