Provider Demographics
NPI:1669565826
Name:ARCHILA, ARTURO P (MD)
Entity type:Individual
Prefix:DR
First Name:ARTURO
Middle Name:P
Last Name:ARCHILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARTURO
Other - Middle Name:PLINIO
Other - Last Name:ARCHILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30 VICTORIA LANE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-906-1865
Mailing Address - Fax:
Practice Address - Street 1:30 VICTORIA LN
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3135
Practice Address - Country:US
Practice Address - Phone:201-906-1865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063072002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7268009Medicaid
NJ7268009Medicaid
NJ730760Medicare ID - Type Unspecified