1730278904 NPI number — KOURKIN TCHORBAJIAN MD

Table of content: KOURKIN TCHORBAJIAN MD (NPI 1730278904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730278904 NPI number — KOURKIN TCHORBAJIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TCHORBAJIAN
Provider First Name:
KOURKIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730278904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 SAINT GEORGES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAHWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07065-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-382-7473
Provider Business Mailing Address Fax Number:
732-382-9045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 SAINT GEORGES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAHWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07065-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-382-7473
Provider Business Practice Location Address Fax Number:
732-382-9045
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA04466600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HS201 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: F03774 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1227571 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0230008 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 57D861 . This is a "WELLCHOICE/ EMPIRE BC/BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 180026962 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4041478 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4294314 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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