Provider Demographics
NPI:1417959834
Name:DEVEJIAN, NEIL SARKIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:SARKIS
Last Name:DEVEJIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:AMC CARDIOTHORACIC SURGERY GROUP
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-5470
Mailing Address - Fax:518-262-5999
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:AMC CARDIOTHORACIC SURGERY GROUP
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5470
Practice Address - Fax:518-262-5999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY218128-12080P0202X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Not Answered2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02101251Medicaid
NYH07371Medicare UPIN
NY02101251Medicaid