Provider Demographics
NPI:1568505832
Name:CANARIO, ARTHUR T (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:T
Last Name:CANARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARTHUR
Other - Middle Name:T
Other - Last Name:CANARIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:111 CENTRAL AVE
Mailing Address - Street 2:FLOOR M2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1909
Mailing Address - Country:US
Mailing Address - Phone:973-877-2654
Mailing Address - Fax:973-877-2656
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:FLOOR M2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-2654
Practice Address - Fax:973-877-2656
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03840600171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54593Medicare UPIN