Provider Demographics
NPI:1750349395
Name:KACHADOURIAN, ANISE A (MD)
Entity type:Individual
Prefix:DR
First Name:ANISE
Middle Name:A
Last Name:KACHADOURIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-1698
Mailing Address - Country:US
Mailing Address - Phone:908-259-8817
Mailing Address - Fax:908-259-8846
Practice Address - Street 1:776 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1698
Practice Address - Country:US
Practice Address - Phone:908-259-8817
Practice Address - Fax:908-259-8846
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71654207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9113304Medicaid
NJ25MA07165400OtherCDS
NJ207RH0003XOtherTAXONOMY CODE
NJ102440Medicare PIN
NJH79356Medicare UPIN
NJ25MA07165400OtherCDS
NJDF1486Medicare PIN
NJ067709VJKMedicare PIN