Provider Demographics
NPI:1558660720
Name:KALAYJIAN, TRO (DO)
Entity Type:Individual
Prefix:
First Name:TRO
Middle Name:
Last Name:KALAYJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SIOUX CT
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1410
Mailing Address - Country:US
Mailing Address - Phone:845-397-2873
Mailing Address - Fax:
Practice Address - Street 1:84 ROUTE 303
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2806
Practice Address - Country:US
Practice Address - Phone:845-397-2873
Practice Address - Fax:888-674-7069
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY89983508207QB0002X
NJ25MB09475200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ352231Medicare PIN