Provider Demographics
NPI:1770584583
Name:AGOPIAN, RAFFI E (MD)
Entity type:Individual
Prefix:
First Name:RAFFI
Middle Name:E
Last Name:AGOPIAN
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 1:1124 E RIDGEWOOD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3941
Mailing Address - Country:US
Mailing Address - Phone:201-689-9100
Mailing Address - Fax:201-689-9108
Practice Address - Street 1:1124 E RIDGEWOOD AVE STE 202
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3941
Practice Address - Country:US
Practice Address - Phone:201-689-9100
Practice Address - Fax:201-689-9108
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59885208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7970404Medicaid
NJ027955BLQMedicare PIN
NJ7970404Medicaid