Provider Demographics
NPI:1609049501
Name:MANOUCHER KATEBIAN, M.D. PA
Entity Type:Organization
Organization Name:MANOUCHER KATEBIAN, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOUCHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KATEBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-342-3800
Mailing Address - Street 1:274 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1432
Mailing Address - Country:US
Mailing Address - Phone:201-342-3800
Mailing Address - Fax:201-343-7320
Practice Address - Street 1:274 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1432
Practice Address - Country:US
Practice Address - Phone:201-342-3800
Practice Address - Fax:201-343-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02875800174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJ6763OtherHEALTHNET
NJBS735OtherOXFORD
NJ442062045OtherRAILROAD MEDICARE
NJ2914204Medicaid
NJ123485Medicare PIN
NJNJ6763OtherHEALTHNET