Aleksandr Martirosov, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB06860100 Issued in NJ

Practice address

31-00 Broadway
1St Floor
Fair Lawn, NJ 07410-3963

Phone

(201) 791-7771

Fax

(201) 791-7337

NPI assigned

Jan 24, 2007

Last updated

Oct 18, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tri-State Health and Wellness Medical Care Center PC

  • Health Service Clinic/Center
  • Fair Lawn, NJ
  • NPI 1942457023
  Medicare reassignment NPD Authorized official
• Heritage Vascular Services PC

  • Family Medicine Physician
  • Bayonne, NJ
  • NPI 1598537623
  NPD Authorized official
• Osteopathic Medical Care Center

  • Primary Care Clinic/Center
  • Fair Lawn, NJ
  • NPI 1730363250
  NPD (past) Authorized official
• Tri-State Healthy

  • Family Medicine Physician
  • Bloomfield, NJ
  • NPI 1215363254
  Authorized official Same address or phone
• Universal Clinic P.C.

  • Family Medicine Physician
  • Southfield, MI
  • NPI 1235131236
  NPD (past) Authorized official
• Bergen Physical & Vein Medicine LLC

  • Specialist
  • Fairview, NJ
  • NPI 1538759394
  NPD
• Dynamic Health Rehabilitation Center PC

  • Specialist
  • Fair Lawn, NJ
  • NPI 1588077705
  NPD
• Tri State Health and Wellness Medical Care Center PC

  • General Practice Physician
  • Fair Lawn, NJ
  • NPI 1154661593

  Addiction Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287360000000",
    "number": "1700931185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31-00 BROADWAY",
            "address_2": "1ST FLOOR",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103963",
            "telephone_number": "201-791-7771",
            "fax_number": "201-791-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31-00 BROADWAY",
            "address_2": "1ST FLOOR",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103963",
            "telephone_number": "201-791-7771",
            "fax_number": "201-791-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIROSOV",
        "first_name": "ALEKSANDR",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2010-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB06860100",
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NJ",
            "license": "25MB06860100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin Koenigsberg D.O. PA.
• Martin N Weiner, MD PA
• Melissa A Martinez
• Tina-Marie Martini, OTR
• Teresa Ann Martino, M.A
• Carly Marut, M.S., CCC-SLP
• Marvin Wisch PA
• Moiza M Maryam
• Laurel-Anne Lauretta Mason
• Jerise M. Massone, D.C.

• Family Medicine Physician in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.