Provider Demographics
NPI:1821198805
Name:SEFERIAN, MIHRAN A (MD)
Entity Type:Individual
Prefix:
First Name:MIHRAN
Middle Name:A
Last Name:SEFERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4371
Mailing Address - Country:US
Mailing Address - Phone:201-503-0660
Mailing Address - Fax:201-503-0685
Practice Address - Street 1:200 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4371
Practice Address - Country:US
Practice Address - Phone:201-503-0660
Practice Address - Fax:201-503-0685
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06284800207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7448601Medicaid
NY02422700Medicaid
G59695Medicare UPIN
NJ7448601Medicaid