Provider Demographics
NPI:1053672238
Name:YOUR FAMILY DOC, P.C.
Entity Type:Organization
Organization Name:YOUR FAMILY DOC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:AVEDIS
Authorized Official - Last Name:KEUKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-314-0889
Mailing Address - Street 1:2 SHERMAN POTTS DR
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075-3216
Mailing Address - Country:US
Mailing Address - Phone:518-314-0889
Mailing Address - Fax:518-244-8812
Practice Address - Street 1:2 SHERMAN POTTS DR
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3216
Practice Address - Country:US
Practice Address - Phone:518-314-0889
Practice Address - Fax:518-244-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty