Provider Demographics
NPI:1609290519
Name:AZARKIAN, EDWIN COHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN COHEN
Middle Name:
Last Name:AZARKIAN
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:ONE ASPEN PLACE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2810
Mailing Address - Country:US
Mailing Address - Phone:516-457-6644
Mailing Address - Fax:516-466-7925
Practice Address - Street 1:111-29 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:516-457-6644
Practice Address - Fax:516-466-7925
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298081207RN0300X, 207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No282N00000XHospitalsGeneral Acute Care Hospital