Provider Demographics
NPI:1316378524
Name:ARISDOV MEDICAL PC
Entity Type:Organization
Organization Name:ARISDOV MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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 1:20 E 46TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2417
Mailing Address - Country:US
Mailing Address - Phone:646-357-3155
Mailing Address - Fax:646-559-4673
Practice Address - Street 1:20 E 46TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2417
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:2013-12-13
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207890207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207890OtherLICENSE