Provider Demographics
NPI:1205861861
Name:ANISE KACHADOURIAN MD LLC
Entity type:Organization
Organization Name:ANISE KACHADOURIAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHADOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-259-8817
Mailing Address - Street 1:11 FOREST PL
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1313
Mailing Address - Country:US
Mailing Address - Phone:908-259-8817
Mailing Address - Fax:908-259-8846
Practice Address - Street 1:777 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1689
Practice Address - Country:US
Practice Address - Phone:908-259-8817
Practice Address - Fax:908-259-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71654207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9113304Medicaid
NJ5750490001Medicare NSC
NJDF1486Medicare PIN
NJH79356Medicare UPIN
NJ102440Medicare PIN