Tri-State Health and Wellness Medical Care Center PC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

TRI-STATE HEALTH AND WELLNESS MEDICAL CARE CENTER PC

Practice address

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

Phone

(201) 791-7771

Fax

(201) 791-7337

NPI assigned

Aug 20, 2008

Organization subpart

No

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

Authorized official

Name

Aleksandr Martirosov, DONPI 1700931185

Title

Family Practice

Phone

(201) 791-7771

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Tax ID family

Tri State Health and Wellness Medical Care Center PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tri State Health and Wellness Medical Care Center PC

  • General Practice Physician
  • Fair Lawn, NJ
  • NPI 1154661593
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aleksandr Martirosov, D.O.

  • Family Medicine Physician
  • Fair Lawn, NJ
  • NPI 1700931185
  Medicare reassignment NPD Authorized official
• Agnieszka Golabek, A.P.N.

  • Adult Health Nurse Practitioner
  • Secaucus, NJ
  • NPI 1346628567
  Medicare reassignment NPD

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381708800000",
    "number": "1942457023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31-00 BROADWAY",
            "address_2": "1ST FL.",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31-00 BROADWAY",
            "address_2": "1ST FL.",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103963",
            "telephone_number": "201-791-7771",
            "fax_number": "201-791-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE HEALTH AND WELLNESS MEDICAL CARE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2013-10-14",
        "status": "A",
        "authorized_official_last_name": "MARTIROSOV",
        "authorized_official_first_name": "ALEKSANDR",
        "authorized_official_title_or_position": "FAMILY PRACTICE",
        "authorized_official_telephone_number": "201-791-7771",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raquel N Torres, BCBA
• Total Renal Care Inc (Fair Lawn Dialysis)
• Irina Trakhtman, MS, RD, CDCES
• Ramona Tranculov, LMFT
• Tri State Health and Wellness Medical Care Center PC
• George Tsangaroulis, D.D.S.
• Galina Tsypin, L.AC.
• Jenna Tucker, PT, DPT, CBIS
• Tune Up Rehabilitation
• Beatrice Jessica Turenne, LPC

• Health Service Clinic/Center in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Health Service Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.