Provider Demographics
NPI:1700020476
Name:AMIROV, ALBERT
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:AMIROV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3503
Mailing Address - Country:US
Mailing Address - Phone:201-488-0654
Mailing Address - Fax:201-883-1619
Practice Address - Street 1:123 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3503
Practice Address - Country:US
Practice Address - Phone:201-488-0654
Practice Address - Fax:201-883-1619
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02481700183500000X
NY045852-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist