Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 22D100870500 | NJ |
NPI | 1134305808 |
---|---|
Provider Name | Dr. Raymond Zareh Darakjian |
First Address | Fort Lee, NJ 07024-1712 |
Second Address | Fort Lee, NJ 07024-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2008 |
Last Update Date | 12/01/2008 |