Provider Demographics
NPI:1992012157
Name:PABLO A. ARTETA, M.D.,P.C.
Entity Type:Organization
Organization Name:PABLO A. ARTETA, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:ARTETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-803-0042
Mailing Address - Street 1:426 57TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2120
Mailing Address - Country:US
Mailing Address - Phone:201-869-6000
Mailing Address - Fax:201-869-6622
Practice Address - Street 1:426 57TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2120
Practice Address - Country:US
Practice Address - Phone:201-869-6000
Practice Address - Fax:201-869-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5857000261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7793006Medicaid
NJ7793006Medicaid
NJF42689Medicare UPIN