Provider Demographics
NPI:1467447029
Name:KHATCHATRIAN, ANDRANIK VAHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRANIK
Middle Name:VAHAN
Last Name:KHATCHATRIAN
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:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-0360
Mailing Address - Country:US
Mailing Address - Phone:516-374-6838
Mailing Address - Fax:516-374-2362
Practice Address - Street 1:1512 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1429
Practice Address - Country:US
Practice Address - Phone:516-374-6838
Practice Address - Fax:516-374-2362
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231254208100000X
NJ25MA09226700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
I05912Medicare UPIN
NY0201ABMedicare PIN
NY0614J1Medicare PIN