Provider Demographics
NPI:1346331980
Name:CHAGLASSIAN, TED
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:CHAGLASSIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0107
Mailing Address - Country:US
Mailing Address - Phone:212-472-7186
Mailing Address - Fax:212-472-8608
Practice Address - Street 1:1001 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0107
Practice Address - Country:US
Practice Address - Phone:212-472-7186
Practice Address - Fax:212-472-8608
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123470208200000X, 2082S0099X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
680641Medicare ID - Type Unspecified
B17931Medicare UPIN