Provider Demographics
NPI:1114244415
Name:ADVANCED CLINICAL PHYSICIANS, P.L.L.C
Entity Type:Organization
Organization Name:ADVANCED CLINICAL PHYSICIANS, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VARUZHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVLATYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-268-8383
Mailing Address - Street 1:11203 QUEENS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5550
Mailing Address - Country:US
Mailing Address - Phone:718-268-8383
Mailing Address - Fax:718-268-6033
Practice Address - Street 1:11203 QUEENS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5550
Practice Address - Country:US
Practice Address - Phone:718-268-8383
Practice Address - Fax:718-268-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAAAASF # 3728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCERT# 3728OtherAAAASF, INC.