Provider Demographics
NPI:1932103355
Name:SHRAYTMAN, ARKADIY (DO)
Entity Type:Individual
Prefix:
First Name:ARKADIY
Middle Name:
Last Name:SHRAYTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 PARISH DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4671
Mailing Address - Country:US
Mailing Address - Phone:973-305-8300
Mailing Address - Fax:973-305-8157
Practice Address - Street 1:468 PARISH DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4671
Practice Address - Country:US
Practice Address - Phone:973-305-8300
Practice Address - Fax:973-305-8157
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07640900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064718Medicaid
NJH12787Medicare UPIN
NJ0064718Medicaid