Provider Demographics
NPI:1568626877
Name:VIRK, HARTAJ S (MD)
Entity Type:Individual
Prefix:DR
First Name:HARTAJ
Middle Name:S
Last Name:VIRK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22-18 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3016
Mailing Address - Country:US
Mailing Address - Phone:201-475-5522
Mailing Address - Fax:201-475-5522
Practice Address - Street 1:22-18 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:201-475-5050
Practice Address - Fax:201-475-5522
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2015-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA082495207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA082495OtherSTATE LICENSE
NJ230046ZNNCMedicare PIN