Provider Demographics
NPI:1962416776
Name:ANTLER, ARTHUR S (MD)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:S
Last Name:ANTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430
Mailing Address - Country:US
Mailing Address - Phone:201-825-0091
Mailing Address - Fax:201-825-8242
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:SUITE 212
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-825-0091
Practice Address - Fax:201-825-8242
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37299207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0547808Medicaid
NJ0547808Medicaid
B5482OtherOXFORD
010037299NJ02OtherANTHEM
245466OtherUNITED HEALTH
040979OtherAETNA
AN173530Medicare ID - Type Unspecified
F06077OtherHEALTH NET
NJ0547808Medicaid
81045OtherAMERIGROUP
110084960OtherRR MCA