Provider Demographics
NPI:1518938422
Name:PRIVEN, IGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:PRIVEN
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 1:345 ROUTE 9 STE 8
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3240
Mailing Address - Country:US
Mailing Address - Phone:732-845-2200
Mailing Address - Fax:732-845-0154
Practice Address - Street 1:345 ROUTE 9 STE 8
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-845-2200
Practice Address - Fax:732-845-0154
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07691500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075655Medicare PIN