Provider Demographics
NPI:1538125588
Name:ERGIN, M ARISAN (MD)
Entity Type:Individual
Prefix:
First Name:M ARISAN
Middle Name:
Last Name:ERGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:48 HASTINGS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1206
Mailing Address - Country:US
Mailing Address - Phone:201-538-2411
Mailing Address - Fax:201-569-4113
Practice Address - Street 1:350 ENGLE STREET
Practice Address - Street 2:STE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-894-3636
Practice Address - Fax:201-541-2188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2016-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA70525208G00000X
NY1258151208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5390907Medicaid
A62219Medicare UPIN
NJ037718N3SMedicare ID - Type Unspecified