Provider Demographics
NPI:1013901842
Name:NALBANDIAN, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:NALBANDIAN
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 1:48 BI-STATE PLAZA
Mailing Address - Street 2:#225
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7079
Mailing Address - Country:US
Mailing Address - Phone:212-254-6882
Mailing Address - Fax:212-254-6886
Practice Address - Street 1:48 BI STATE PLZ # 225
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7003
Practice Address - Country:US
Practice Address - Phone:212-254-6882
Practice Address - Fax:212-254-6886
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2106512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01936992Medicaid
NYH36492Medicare UPIN
NY0N5851Medicare ID - Type Unspecified