Provider Demographics
NPI:1073158820
Name:MEDICAL ONE OFFICE PC
Entity Type:Organization
Organization Name:MEDICAL ONE OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VARUZHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVLATYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-357-3155
Mailing Address - Street 1:1468 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2329
Mailing Address - Country:US
Mailing Address - Phone:718-434-1799
Mailing Address - Fax:
Practice Address - Street 1:20 E 46TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9249
Practice Address - Country:US
Practice Address - Phone:646-357-3155
Practice Address - Fax:646-559-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty