Provider Demographics
NPI:1851307417
Name:GULEKJIAN, JACQUES AGOP (MD)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:AGOP
Last Name:GULEKJIAN
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 1:113 PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1915
Mailing Address - Country:US
Mailing Address - Phone:201-214-3380
Mailing Address - Fax:201-567-3673
Practice Address - Street 1:113 PERSHING RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1915
Practice Address - Country:US
Practice Address - Phone:201-214-3380
Practice Address - Fax:201-567-3673
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1318762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00349239Medicaid
NY00349239Medicaid
NYB13018Medicare UPIN
NY324191Medicare ID - Type UnspecifiedEMPIRE