Provider Demographics
NPI:1174591762
Name:HOWHANNESIAN, ANDRANIK
Entity type:Individual
Prefix:
First Name:ANDRANIK
Middle Name:
Last Name:HOWHANNESIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HARRISTOWN RD FL 2
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3329
Mailing Address - Country:US
Mailing Address - Phone:201-855-8446
Mailing Address - Fax:201-444-0350
Practice Address - Street 1:14-01 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2008
Practice Address - Country:US
Practice Address - Phone:201-791-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06432200208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG35726Medicare UPIN
NJLO3892866Medicare ID - Type Unspecified