Provider Demographics
NPI:1063061604
Name:ARTIN, IRIS BEN (PA)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:BEN
Last Name:ARTIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:MIROSLAV
Other - Middle Name:
Other - Last Name:JURISIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BOSTON PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4407
Mailing Address - Country:US
Mailing Address - Phone:617-953-7243
Mailing Address - Fax:
Practice Address - Street 1:29 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1024
Practice Address - Country:US
Practice Address - Phone:617-958-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4440363A00000X
NY023789363A00000X
NJ25MP00536100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant