Provider Demographics
NPI:1508059205
Name:CHOULDJIAN-BAGHDASSARIAN, ANI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANI
Middle Name:
Last Name:CHOULDJIAN-BAGHDASSARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ARLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1324
Mailing Address - Country:US
Mailing Address - Phone:516-487-6273
Mailing Address - Fax:
Practice Address - Street 1:40 MIDDLE NECK RD
Practice Address - Street 2:SUITE A-3
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2307
Practice Address - Country:US
Practice Address - Phone:516-466-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2453822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry