Provider Demographics
NPI:1184659419
Name:NISHANIAN, ERVANT V (MD)
Entity Type:Individual
Prefix:
First Name:ERVANT
Middle Name:V
Last Name:NISHANIAN
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 1:622 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-9876
Mailing Address - Fax:212-342-2139
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-9876
Practice Address - Fax:212-342-2139
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81166207L00000X
NY218145207L00000X
MDD 0052984207L00000X
DCMD31319207L00000X
NJMA073376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology